臀大肌代肛门括约肌治疗高位无肛术后大便失禁  

GLUTEUS MAXIMUS TRANSPLANTATION FOR FECAL INCONTINENCE AFTER SURGERY OF HIGH ANAL ATRESIA

作　　者：孔飞腾[1] 李福玉[1] 刘菊先[2] 陈咏梅[1] 吴杨[1] 杨晓东[1] 向波[1] 

机构地区：[1]四川大学华西医院小儿外科,成都610041 [2]四川大学华西医院超声诊断科

出　　处：《中国修复重建外科杂志》2012年第5期571-575,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨臀大肌代肛门括约肌控便手术治疗高位无肛术后大便失禁的疗效。方法 2002年12月-2010年11月,收治25例高位无肛行腹会阴联合肛门成形术后完全性大便失禁患者,采用臀大肌代肛门括约肌控便手术治疗。男11例,女14例;年龄3～22岁,平均10.2岁。术前直肠造影、肛管直肠测压及肌电图检查显示肛门括约肌功能缺失或严重不良。采用Wexner评分、大便失禁生活质量调查问卷(FIQL)、自测健康评定量表(SRHMS)评定患者生活质量,并行肛管直肠测压、肛管直肠腔内超声检查、动态排便造影检查。结果术后1周2例患者发生直肠切口瘘,其余患者切口Ⅰ期愈合。患者均获随访,随访时间1～9年,平均6.3年。大便次数由术前每天10余次减少至4～6次。术后1年及术后2年及以上Wexner评分及SRHMS自测评分与术前比较,差异均有统计学意义(P<0.05);术后2年及以上FIQL评分较术前及术后1年明显改善(P<0.05)。肛管直肠测压结果示术后2年及以上患者肛管最大收缩压、收缩持续时间及最大收缩容积较术前及术后1年明显提高,差异有统计学意义(P<0.05)。结论臀大肌代肛门括约肌手术能一定程度改善高位无肛术后大便失禁患者的控便能力。Objective To investigate the application of gluteus maximus transplantation for fecal incontinence after surgery of high anal atresia. Methods Between December 2002 and November 2010, 25 patients with fecal incontinence were treated with gluteus maximus transplantation, which was caused by surgery of high anal atresia. There were 11 males and 14 females with an average age of 10.2 years （range, 3-22 years）. Preoperative radiography, anorectal manometer, and electromyogram showed abnormality or deficiency of anal sphincter function. Wexner score, Fecal Incontinence Quality of Life （FIQL） questionnaire, and Self-rated Health Measurement Scale Version 1.0 （SRHMS） score were used to evaluate lifequality of the patients. The anorectal manometer, intra-rectal ultrasound examination, and defecation radiography wereperformed. Results Healing of incision by first intention was achieved in 23 cases and rectal-wound fistula occurred in 2 cases. The follow-up time was 1 to 9 years （mean, 6.3 years）. Defecation frequency was decreased from more than 10 times to 4-6 times every day. Wexner score and SRHMS were significantly improved at 1 or 2 years after surgery when compared withpreoperative socres （P 〈 0.05）. FIQL was also significantly improved after 2 years （P 〈 0.05）. At 2 years after surgery, the anal maximum systolic pressure, contraction duration, and maximum systolic volume were improved, showing significant differences when compared with those at preoperation and 1 year after surgery （P 〈 0.05）. Conclusion Gluteus maximus transplantation can improve defecation controls in the patients with fecal incontinence after surgery of high anal atresia.

关 键 词：臀大肌 肛门括约肌 高位无肛 大便失禁 

分 类 号：R726.5[医药卫生—儿科]