改良股薄肌移植术治疗肛门失禁的疗效探讨  

Effectiveness of modified gracilis muscle transplantation for anal incontinence

作　　者：李雪青 张作兴[1,2] Li Xueqing;Zhang Zuoxing(Treatment Center for Colorectal Diseases,Tianjin Union Medical Center,Tianjin 300121,China;Tianjin Institute of Coloproctology,Tianjin 300121,China;School of Medicine,Nankai University,Tianjin 300071,China)

机构地区：[1]天津市人民医院肛肠病诊疗中心,天津300121 [2]天津市大肠肛门病研究所,天津300121 [3]南开大学医学院,天津300071

出　　处：《结直肠肛门外科》2022年第6期558-562,共5页Journal of Colorectal & Anal Surgery

摘　　要：目的探讨改良股薄肌移植术治疗肛门失禁的疗效。方法1964年9月至2021年8月,117例肛门失禁患者于天津市人民医院(原天津市滨江医院)接受传统股薄肌移植肛门外括约肌成形术或改良股薄肌移植术治疗,传统术式将股薄肌肌束呈“α”形绕行肛周,改良术式将股薄肌肌束呈“U”形绕行肛周。本研究对术后6个月随访资料完整的34例患者的临床数据进行回顾性分析,其中有12例接受传统术式治疗(传统术式组),有22例接受改良术式治疗(改良术式组)。记录并比较两组临床疗效,手术前后肛门失禁情况(Wexner肛门失禁评分),术后蹲位排粪困难(肛门绞锁)、切口感染的发生情况,手术切口数目,术后首次排粪时间,术后粪便性状评分(依据Bristol粪便分类法评分)。结果两组治疗有效比例比较差异无统计学意义(P>0.05)。两组术前、术后Wexner肛门失禁评分比较差异均无统计学意义(均P>0.05),两组手术前后Wexner肛门失禁评分差值比较差异无统计学意义(P>0.05),两组术后Wexner肛门失禁评分均较组内术前降低(均P<0.05)。改良术式组术后蹲位排粪困难(肛门绞锁)、切口感染的发生情况均优于传统术式组(均P<0.05)。改良术式组手术切口数目少于传统术式组(P<0.05)。两组术后首次排粪时间、术后粪便性状评分比较差异均无统计学意义(均P>0.05)。结论改良股薄肌移植术是治疗肛门失禁的有效术式,可改善患者的肛门失禁症状,且手术操作安全性良好。与传统股薄肌移植肛门外括约肌成形术相比,改良术式的股薄肌肌束绕行简化,有助于减少术后蹲位排粪困难(肛门绞锁)、切口感染的发生。Objectives To explore the effectiveness of modified gracilis muscle transplantation for anal incontinence.Methods A total of 117 patients with anal incontinence were treated at Tianjin Union Medical Center(Tianjin Binjiang Hospital)between September 1964 and August 2021 with traditional gracilis muscle transplantation for external sphincteroplasty(gracilis muscle bundle presented with“α”encircling the anal)or modified gracilis muscle transplantation(gracilis muscle bundle presented with“U”encircling the anal).This retrospective analysis comprised 34 patients with complete follow-up data for 6 months after surgery,including 12 patients in the traditional group(receiving traditional procedure)and 22 patients in the modified group(receiving modified procedure).The followings were recorded and compared between the two groups:clinical effectiveness,anal incontinence evaluated by the Wexner anal incontinence sore before and after surgery,postoperative difficulty in defecation at squatting position(anal twist),incision infection,number of incisions,time to the first postoperative bowel movement,score of postoperative stool characteristics(the Bristol Stool Scale).Results The overall clinical effectiveness was not statistically different between the two groups(P>0.05).Wexner anal incontinence scores before and after surgery were comparable between the two groups(P>0.05).The two groups did not differ significantly regarding the change in Wexner anal incontinence score before and after surgery(P>0.05).Within each group,Wexner anal incontinence score decreased significantly after surgery(P<0.05),the postoperative difficulty in defecation at squatting position(anal twist)and incision infection were less in the modified group than in the traditional group(P<0.05).The modified group had significantly fewer incisions(P<0.05).The two groups did not differ significantly regarding time to the first postoperative bowel movement and score of postoperative stool characteristics(P>0.05).Conclusion Modified gracilis muscle tra

关 键 词：肛门失禁 股薄肌移植术 排粪困难 肛门绞锁 切口感染 

分 类 号：R657.1[医药卫生—外科学]