臀大肌瓣移位在治疗神经源性大便失禁中的作用  

Gluteus maximus flap transposition for the treatment of neurogenic fecal incontinence in children

作　　者：王若义[1] 丁庆光[1] 陈维秀[1] 孙小兵[1] 李金良[1] 陈雨历[1] 

机构地区：[1]山东大学第二医院小儿外科,济南250033

出　　处：《中华小儿外科杂志》2011年第2期116-119,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨臀大肌瓣移位肛提肌加强术在治疗儿童神经源性大便失禁中的作用。方法2006年1月至2009年12月在我院行臀大肌瓣移位肛提肌加强术13例，其中男9例，女4例，手术年龄7～16岁，平均13．2岁，患儿术前均有明确的脊髓拴系松解手术史，在手术前均行盆底肌电图检查、盆底肌MR、结肠传输试验检查，严格掌握手术适应证，手术前后均行肛门直肠测压、临床疗效评价。结果术后12例患儿获得随访，术前盆底肌电图均表现为神经源性损害，且为失代偿期。结肠传输试验表现为混合型10例，出口梗阻型3例，盆底肌MR见13例患儿肛提肌发育不对称或肛提肌不能清楚显示，肛门直肠测压手术前后均未见明显变化，临床评分结果示13例患儿均表现为完全性大便失禁，评分差，术后患儿的临床表现优0例，良8例，差4例。结论臀大肌瓣移位肛提肌加强术有利于改善神经源性大便失禁的排便状况。Objective To study the efficacy of gluteus maximus flap transposition for the treatment of neurogenic fecal incontinence in children. Methods Between January 2006 and December 2009, 7 males and 4 females were diagnosed with neurogenic fecal incontinence and underwent surgery at this center. Their age ranged from 7 to 16 years old （mean age, 13.2 years）. All the children had a history of tethered spinal cord release surgery. Before surgery, all patients had pelvic floor electro- myography, colonic transit test, anorectal manometry, and pelvic floor MRI. The patients were followed up after surgery. The clinical data were retrospectively analyzed to evaluate the efficacy of the surgery. Results Pelvic floor electromyography found the uncompensated nerve function impairment before surgery. Colonic transit test found 10 patients had neurogenic fecal incontinence, and 3 had outlet obstruction. Anorectal manometry measurements of these patients didn＇t have any changes after surgery. The anorectal function was scored fair on 8 patients, and poor on 4. Conclusions Gluteus maximus flap transposition is effective to improve the anorectal function on the patients with neurogenic fecal incontinence.

关 键 词：大便失禁 神经源性 臀大肌瓣移位术 

分 类 号：R726.5[医药卫生—儿科]