神经源性大便失禁治疗后排便功能的初步观察  

The preliminary results of management of neurogenic fecal incontinence

作　　者：李威[1] 陈雨历[1] 董志行[1] 崔新海[1] 袁峰[1] 

机构地区：[1]山东医科大学附属医院小儿外科,济南250012

出　　处：《中华小儿外科杂志》2000年第1期32-34,共3页Chinese Journal of Pediatric Surgery

基　　金：卫生部临床学科重点资助![49(118)]

摘　　要：目的　观察神经源性大便失禁治疗后的排便功能。方法　本组２８ 例，年龄４ ～１２ 岁，手术方式为双侧髂腰肌转移盆底肌加强或替代术，术后第３ 周起行康复训练，采用临床主观评定、钡灌肠以及直肠肛管测压相结合的方式对其肛门功能进行评价。结果　术前、康复训练前、康复训练后、术后２ 年以及术后５ 年以上的临床主观评分分别为１．７ ±０．４ 、２．５ ±０．６ 、３．５±０ ．５ 、４ ．３ ±０ ．４ 和４．８±０．６；客观评分分别为２．２ ±０．５ 、２．７ ±０．６、３ ．４ ±０ ．４、４ ．１ ±０ ．５ 和４．０ ±０．７；耻肛尾（ＰＡＣ） 三角的Ａ 角由（９２ ．７±７ ．２）°提高到（１１４ ．３±１１ ．６）°。结论　髂腰肌盆底悬吊及术后康复训练是治疗小儿神经源性大便失禁的有效方法；应制定一个系统而全面的治疗计划和肛门评定方案。Objective To evaluate the results of the treatment for neurogenic fecal incontinence.Methods Twenty eight patients with neurogenic fecal incontinence (4 to 12 years of age), underwent suspension of pelvic floor by bilateral transposition of iliopsoas muscle. Pelvic floor training was started 3 weeks post operatively. The continence was assessed on clinical symptoms, Barium enema and anal manometry.Results Pre operative, immediate post operative, post training, 2 and 5 year post operative subjective scores were 1.7 +/- 0.4 , 2.5 +/- 0.6 , 3.5 +/- 0.5 , 4.3 +/- 0.4 and 4.8 +/- 0.6 respectively; the corresponding objective scores were 2.2 +/- 0.5 , 2.7 +/- 0.6 , 3.4 +/- 0.4 , 4.1 +/- 0.5 and 4.0 +/- 0.7 . The A angle of the posterior anococcygeal triangle increased from 92.7° +/- 7.2° to 114.3° +/- 11.6 °.Conclusion Suspension of pelvic floor with iliopsoas in combination with post operative training is effective in managing neurogenic fecal incontinence.

关 键 词：大便失禁 肛门 外科手术 排便功能 

分 类 号：R726.5[医药卫生—儿科]