Pna手术及盆底肌肉折叠术在肛门闭锁术后大便失禁中的应用  

P nas Approach and Levator Ani Imbrication on Postoperative Fecal Incontinence in Children with Imperforate Anus

作　　者：李龙[1] 张金哲[1] 王燕霞[1] 刘荫棠[1] 陈亚军[1] 李平[1] 潘云港[1] 徐延波 

机构地区：[1]首都医科大学附属北京儿童医院外科,100045

出　　处：《中华小儿外科杂志》1999年第5期277-279,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的　了解Ｐｅ～ｎａ 手术及盆底肌折叠术治疗无肛术后大便失禁的效果。方法　采用再次Ｐｅ～ｎａ 手术和盆底肌折叠术治疗高中位无肛畸形术后大便失禁患儿９ 例（ 平均年龄６ ．３ 岁）。术中见９ 例患儿肛门和直肠均未穿过横纹肌复合体的中心，其中４ 例新生儿期行腹会阴肛门成形术的患儿，直肠偏于复合体的左侧或右侧，另外５ 例直肠偏于复合体的前方。术中将直肠重新固定在横纹肌复合体之中心。结果　术后随访半年到两年，显示患儿的排便控制功能均有改善，３ 例术前临床评分为０ 者，术后增加到４ ～５ 分，２ 例术前１ 分者，术后增加到５ 分和６ 分，３ 例２ 分者增加到５ ～６ 分，另１ 例３ 分者增加到６ 分。肛门直肠测压显示：术前和术后肛管的静息压力变化不明显，而收缩压力增加显著，由术前的（３０ ．８±１６ ．４）ｍ ｍ Ｈｇ 增加到（５２ ．７ ±１１ ．１）ｍ ｍ Ｈｇ。结论　直肠错过横纹肌复合体中心是高中位肛门畸形患儿术后大便失禁的病因之一。再次行Ｐｅ～ｎａObjective To evaluate posterior sagittal anorectal pullthrough(P e ～na’s operation) and levator ani imbrication in the management of postoperative fecal incontinence in children with imperforate anus. Methods Incontinent children( n =9, mean age= 6.3 years) with high type imperforate anus were reconstructed using P e ～na’s approach and levator ani imbrication. Operative findings in all 9 children revealed that the anorectal canals were not positioned in the center of the muscle complex. In 4 patients who were operated on in neonatal period, the rectum was misplaced in the anterio lateral position. The remaining 5 had the rectum positioned anterior to the muscle complex. The second operation repositioned the rectum in the center of the muscle complex. Results The patients were followed up for 2 years. All 9 children showed some degree of improvement. Post operatively the functional scores improved from 0 to 4-5 in 3 patients, from 1 to 5-6 in 2 patients, from 2 to 5-6 in 3 and from 3 to 6 in one. Anorectal manometry did not demonstrate significant change in resting pressure but the contraction pressure improved from( 30.8 ± 16.4 )mmHg to( 52.7 ± 11.1 )mmHg post operatively. Conclusions The study demonstrates that failure to position the rectum in the center of muscle complex is one of the causes of post operative fecal incontinence in children with imperforate anus. Reconstruction using P e ～na’s approach and levator ani imbrication may improve the fecal continence.

关 键 词：肛门闭锁 便失禁 Pna手术 盆底肌肉折叠术 

分 类 号：R726.571.1[医药卫生—儿科]