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1.
Lepistö A Pinta T Kylänpää ML Halmesmäki E Väyrynen T Sariola A Stefanovic V Aitokallio-Tallberg A Ulander VM Molander P Luukkonen P 《Diseases of the colon and rectum》2008,51(4):421-425
Purpose This study was designed to evaluate prospectively the results of the overlap technique in primary sphincter reconstruction
after obstetric tear.
Methods Obstetric tears in 44 women were operated on with primary overlap reconstruction. These women were investigated six to nine
months after the operation. Results were compared with those of a historical control group of 52 women whose obstetric sphincter
rupture had been treated with the end-to-end technique.
Results The overlap group had significantly more incontinence symptoms after delivery and repair of the sphincter tear than before
delivery (P < 0.0001); however, their incontinence symptoms were significantly fewer than those of the end-to-end group (P = 0.004). The prevalence of persistent rupture of the external anal sphincter was significantly lower in the overlap group
(6/44, 13.6 percent) than in the end-to-end group (39/52, 75 percent; P < 0.0001). Internal anal sphincter rupture occurred in 5 patients (11.4 percent) in the overlap group and in 40 patients
(76.9 percent) in the end-to-end group (P < 0.0001).
Conclusions The overlap technique should be adopted as the method of choice for primary sphincter repair after obstetric tear. 相似文献
2.
Immediate repair of obstetric anal sphincter rupture: medium-term outcome of the overlap technique 总被引:4,自引:2,他引:2
Kairaluoma MV Raivio P Aarnio MT Kellokumpu IH 《Diseases of the colon and rectum》2004,47(8):1358-1363
PURPOSE: Overlap sphincteroplasty is gaining popularity in the primary repair of obstetric sphincter ruptures. This study was designed to evaluate the medium-term outcome of the overlap technique.METHODS: Between August 1997 and October 2001, 31 consecutive females who were diagnosed with a complete third-degree or fourth-degree anal sphincter rupture underwent overlap sphincteroplasty immediately after delivery. Thirty of the females were followed-up for a median of 24 months. The outcome was assessed by clinical examination, anal endosonography, Wexner score, and pelvic floor electromyography.RESULTS: Median 24 (range, 12–63) months after delivery, 23 females (77 percent) were free of symptoms of anal incontinence. Occasional incontinence to flatus and liquid stool occurred in 17 and 7 percent of patients, respectively. Seven percent of patients had a Wexner incontinence score of > 9. The maximum mean resting pressure was 55 (range, 20–90) mmHg, and the maximum mean incremental squeeze pressure was 37 (range, 14–95) mmHg. On anal endosonography, an unrecognized internal sphincter rupture was found in one and a failed repair in two females. Overlap of the external sphincter was demonstrated in 29 patients (97 percent). One female with anal incontinence and persisting external sphincter rupture underwent redo sphincteroplasty.CONCLUSIONS: The median-term outcome of primary overlap repair for obstetric sphincter rupture is good; however, larger, randomized studies with a longer follow-up are needed to evaluate the advantage of this technique over the end-to-end technique.Reprints are not available.Presented at the meeting of Nordic Urogynecologic Association, Helsinki, Finland, January 24 to 25, 2002. 相似文献
3.
Jarrett ME Dudding TC Nicholls RJ Vaizey CJ Cohen CR Kamm MA 《Diseases of the colon and rectum》2008,51(5):531-537
Purpose Sphincter repair is the standard treatment for fecal incontinence secondary to obstetric external anal sphincter damage; however,
the results of this treatment deteriorate over time. Sacral nerve stimulation has become an established therapy for fecal
incontinence in patients with intact sphincter muscles. This study investigated its efficacy as a treatment for patients with
obstetric-related incontinence.
Methods Fecally incontinent patients with external sphincter defects who would normally have undergone overlapping sphincter repair
as a primary or repeat procedure were included. Eight consecutive women (median age, 46 (range, 35–67) years) completed temporary
screening; all eventually had permanent implantation.
Results Six of eight patients had improved continence at median follow-up of 26.5 (range, 6–40) months. Fecal incontinent episodes
improved from 5.5 (range, 4.5–18) to 1.5 (range, 0–5.5) episodes per week (P = 0.0078). Urgency improved in five patients, with ability to defer defecation improving from a median of <1 (range, 0–5)
minute to 1 to 5 (range, 1 to >15) minutes (P = 0.031, all 8 patients). There was no change in anal manometry or rectal sensation. There was significant improvement in
lifestyle, coping/behavior, depression/self-perception, and embarrassment as measured by the American Society of Colon and
Rectal Surgery fecal incontinence quality of life score.
Conclusions Sacral nerve stimulation is potentially a safe and effective minimally invasive treatment for fecal incontinence in patients
with de novo external anal sphincter defects or defects after unsuccessful previous external anal sphincter repair, although numbers remain
small.
Dr. Michael Kamm is a consultant to and received research support from Medtronic, however, study design, performance, analysis,
and reporting have been conducted without the influence of Medtronic. 相似文献
4.
Pinta TM Kylänpää ML Salmi TK Teramo KA Luukkonen PS 《Diseases of the colon and rectum》2004,47(1):18-23
PURPOSE:
This study was designed to evaluate the clinical outcome of primary anal sphincter repair caused by obstetric tears and to analyze possible risk factors associated with sphincter rupture during vaginal delivery.
METHODS:
A total of 52 females with a third-degree or fourth-degree perineal laceration during vaginal delivery were examined. The symptoms of anal incontinence were obtained by a standard questionnaire. In addition to a clinical examination, endoanal ultrasound, anal manometry, and pudendal nerve terminal motor latency examinations were performed. A control group consisted of 51 primiparous females with no clinically detectable perineal laceration after vaginal delivery.
RESULTS:
After primary sphincter repair, 31 females (61 percent) had symptoms of anal incontinence. Fecal incontinence occurred in 10 females (20 percent). According to Hardcastle and Parks and Jorge and Wexners classifications, the study group had more severe symptoms of anal incontinence than the control group (P < 0.001 in both classification groups). In endoanal ultrasound examination, a persistent defect of the external anal sphincter was found in 39 females (75 percent) in the rupture group compared with 10 females (20 percent) in the control group (P < 0.001). Anal sphincter pressures were significantly lower in the rupture group than in the control group. An abnormal presentation was the only risk factor for anal sphincter rupture during vaginal delivery.
CONCLUSIONS:
After primary sphincter repair, persistent external anal sphincter defect and symptoms of anal incontinence are common in females who have had a primary sphincter repair after vaginal delivery. The means of improving the results of primary repair should be studied further.
Supported by the Helsinki University Central Hospital Research Funds and by grants from the Foundation of Gastroenterological Disease of Finland and the Instrumentarium Scientific Foundation 相似文献
5.
Huebner M Margulies RU Fenner DE Ashton-Miller JA Bitar KN DeLancey JO 《Diseases of the colon and rectum》2007,50(9):1405-1411
Purpose Age can affect the delicate physiologic balance of the internal anal sphincter diameters and pressure governed by Laplace’s
law. This study compares the effect of aging on the internal anal sphincter thickness and diameter in younger and older nulliparous
females without symptoms of fecal incontinence undisturbed by an endoanal probe.
Methods Magnetic resonance images were selected from a large database of nulliparous females to form two groups: “younger” females,
aged 30 years and younger (n = 32), and “older” females, aged 50 years and older (n = 32). All patients were scanned without
endoanal coils to allow undistorted measurement of the internal anal sphincter diameters. Inner and outer diameters were measured
from axial magnetic resonance images and used to calculate sphincter thickness and mean radius by two independent investigators
blinded to patient age.
Results The mean age in the younger group was 26 ± 2.8 years, whereas that of the older group was 61.8 ± 7.6 years. Older females
had a 33 percent thicker internal anal sphincter (younger vs. older: 4.5 ± 0.7 vs. 5.9 ± 1 mm; P < 0.001), a 20 percent larger inner diameter (7.1 ± 1.3 vs. 8.5 ± 1.8 mm; P = 0.001), and a 27 percent larger outer diameter (16 ± 2.1 vs. 20.3 ± 3.3 mm; P < 0.001) than younger females. Neither sphincter thickness nor inner or outer diameter correlated with body mass index.
Conclusions There is an increase in internal anal sphincter thickness, inner diameter, and outer diameter, which correlates with age in
asymptomatic nulliparous females.
Supported by the National Institutes of Health, ORWH & NICHD Sex & Gender Factors Affecting Women’s Health SCOR: P50, and
NICHD R01 HD 044406: NICHD R01 DK 051405, R01 HD 038665; German Research Foundation (DFG, HU1502/1–1).
Presented as a poster at the annual meeting of the American Urogynecologic Society, October 19 to 21, 2006, Palm Springs,
Florida.
Presented as an oral poster at the annual meeting of the International Urogynecological Association, September 6 to 9, 2006,
Athens, Greece.
Presented as an oral poster and oral presentation at the annual meeting of the German Association of Gynecology and Obstetrics,
September 19 to 22, 2006, Berlin, Germany. 相似文献
6.
Purpose This prospective study was designed to assess the effectiveness of sacral nerve stimulation for fecal incontinence in patients
with external anal sphincter defect and to evaluate its efficacy regarding presence and size of sphincter defect.
Methods Fifty-three consecutive patients who underwent sacral nerve stimulation for fecal incontinence were divided into two groups:
external anal sphincter defect group (n = 21) vs. intact sphincter group (n = 32). Follow-up was performed at 3, 6, and 12 months with anorectal physiology, Wexner’s score,
bowel diary, and quality of life questionnaires.
Results The external anal sphincter defect group (defect <90°:defect 90°–120° = 11:10) and intact sphincter group were comparable
with regard to age (mean, 63 vs. 63.6) and sex. Incidence of internal anal sphincter defect and pudendal neuropathy was similar. All 53 patients benefited
from sacral nerve stimulation. Weekly incontinent episodes decreased from 13.8 to 5 (P < 0.0001) for patients with external anal sphincter defects and from 6.7 to 2 (P = 0.001) for patients with intact sphincter at 12-month follow-up. Quality of life scores improved in both groups (P < 0.0125). There was no significant difference in improvement in functional outcomes after sacral nerve stimulation between
patients with or without external anal sphincter defects. Clinical benefit of sacral nerve stimulation was similar among patients
with external anal sphincter defects, irrespective of its size. Presence of pudendal neuropathy did not affect outcome of
neurostimulation.
Conclusions Sacral nerve stimulation for fecal incontinence is as effective in patients with external anal sphincter defects as those
with intact sphincter and the result is similar for defect size up to 120° of circumference.
†Deceased. 相似文献
7.
Purpose This study was designed to compare the results of controlled lateral internal sphincterotomy by using anal calibrators with
those of sphincterotomy up to the fissure apex in a randomized, prospective fashion.
Methods In the fissure apex group, sphincterotomy was extended to the level of the fissure apex, and in the spasm-controlled group,
serial small sphincterotomies and anal caliber measurements followed until an anal caliber of 30 mm was obtained.
Results The preoperative anal caliber was 24 ± 1.9 (range, 20–28) mm and 24.9 ± 2.44 (range, 19–28) mm in the spasm-controlled and
fissure apex groups, respectively (P = 0.127). Postoperatively, the spasm-controlled group had a mean anal caliber of 31.5 ± 1.28 (range, 30–32) mm, and the fissure
apex group had 32.5 ± 2.33 (range, 25–37) mm (P = 0.035). In the fissure apex group, a significant negative correlation was determined between the postoperative anal caliber
and time of relief of pain (r = −0.568, P = 0.001). The early (7 and 28 days) postoperative anal incontinence scores were significantly higher in the fissure apex
group (P = 0.002, P < 0.0001, respectively). A significant positive correlation between the anal caliber measurements and anal incontinence scores
at 28 days and 2 months also was noted in the fissure apex group (r = 0.406, P = 0.023; and r = 0.364, P = 0.044).
Conclusions Controlled sphincterotomy provided a faster relief of pain, and it was associated with a lower rate of early postoperative
disturbance of continence and an insignificantly lower rate of treatment failure compared with sphincterotomy up to the fissure
apex.
Reprints are not available 相似文献
8.
Lorenzi B Pessina F Lorenzoni P Urbani S Vernillo R Sgaragli G Gerli R Mazzanti B Bosi A Saccardi R Lorenzi M 《Diseases of the colon and rectum》2008,51(4):411-420
Purpose Sphincter injury is a common cause of anal incontinence. Surgical repair remains the operation of choice; however, the outcome
often is poor. We investigated the ability of injected bone marrow-derived mesenchymal stem cells to enhance sphincter healing
after injury and primary repair in a preclinical model.
Methods Twenty-four inbred Wistar Furth rats were divided into three groups. As a control, Group A underwent sham operation. Group
B had sphincterotomy and repair of both anal sphincters plus saline injections. The study group (Group C) underwent sphincterotomy
and repair followed by intrasphincteric injections of syngenic bone marrow-derived mesenchymal stem cells. A further group
(Group D) of outbred Wistar rats treated with mesenchymal stem cells and immunosuppressive therapy also was evaluated. At
30 days, histologic and morphometric analysis and in vitro contractility testing was performed.
Results A significant decrease of muscle tissue was observed at the site of repair after sphincter injury. However, in Groups C and
D, histologic examination demonstrated new muscle fibers and morphometric analysis revealed a significantly greater muscle
area fraction than in Group B (P < 0.05). Moreover, mesenchymal stem cells injection improved contractility of sphincters strips compared with Group B (P < 0.05). No significant differences were found between Groups C and D.
Conclusions In our experimental model, bone marrow-derived mesenchymal stem cells injection improved muscle regeneration and increased
contractile function of anal sphincters after injury and repair. Therefore, mesenchymal stem cells may represent an attractive
tool for treating anal sphincter lesions in humans. Investigations into the biologic basis of this phenomenon should increase
our knowledge on underlying mechanisms involved in sphincter repair.
Supported by a grant from the University of Siena (PAR 2005).
Address of correspondence: Marco Lorenzi, M.D., Department of Surgery, University of Siena, Viale Bracci, 53100 Siena, Italy. 相似文献
9.
Melenhorst J Koch SM van Gemert WG Baeten CG 《International journal of colorectal disease》2008,23(1):107-111
Background and aims Faecal incontinence (FI) is a socially devastating problem. The treatment algorithm depends on the aetiology of the problem.
Large anal sphincter defects can be treated by sphincter replacement procedures: the dynamic graciloplasty and the artificial
bowel sphincter (ABS).
Materials and methods Patients were included between 1997 and 2006. A full preoperative workup was mandatory for all patients. During the follow-up,
the Williams incontinence score was used to classify the symptoms, and anal manometry was performed.
Results Thirty-four patients (25 women) were included, of which, 33 patients received an ABS. The mean follow-up was 17.4 (0.8–106.3)
months. The Williams score improved significantly after placement of the ABS (p < 0.0001). The postoperative anal resting pressure with an empty cuff was not altered (p = 0.89). The postoperative ABS pressure was significantly higher then the baseline squeeze pressure (p = 0.003). Seven patients had an infection necessitating explantation. One patient was successfully reimplanted.
Conclusion The artificial bowel sphincter is an effective treatment for FI in patients with a large anal sphincter defect. Infectious
complications are the largest threat necessitating explantation of the device. 相似文献
10.
Purpose The study was designed to determine the effect of further vaginal delivery on anal sphincter function in women after apparently
uncomplicated primiparous forceps delivery.
Methods Fifty-two secundigravid women whose first child was forceps-assisted were compared with a control group of 20 women who had
undergone spontaneous first vaginal delivery. Both groups were studied antenatally and again at 12 weeks after second delivery
using a standardized bowel function questionnaire, endoanal ultrasound, and anal manometry. The primary outcome was fecal
incontinence score after second delivery.
Results Before second delivery, 20 of 52 (39 percent) of the forceps group and 3 of 20 (15 percent) control subjects (P = 0.103) reported minor alteration in fecal incontinence. Endoanal ultrasound was more frequently abnormal (38/52 (73 percent)
vs. 6/20 (30 percent); P = 0.002), and median anal canal squeeze (71 vs. 104 mmHg; P = 0.004) and resting pressures (43 vs. 58 mmHg; P = 0.004) were lower in the forceps group. There was no difference in continence score between first and second delivery for
the forceps group (P = 0.19) group or control subjects (P = 0.18). However, 10 of 38 (26 percent) women with an abnormal endoanal ultrasound after first forceps delivery developed
new or worsening symptoms after second delivery.
Conclusions One-quarter of women with occult anal sphincter injury after first forceps delivery experienced some minor alteration in fecal
continence after the second delivery.
Presented at the 23rd annual meeting of the Society for Maternal Fetal Medicine, San Francisco, California.
Supported by the Irish Health Research Board. 相似文献
11.
PURPOSE:
Third-degree tears are generally managed by primary anal sphincter repair. Postoperatively, some physicians recommend laxative use, whereas others favor bowel confinement after anorectal reconstructive surgery. This randomized trial was designed to compare a laxative regimen with a constipating regimen in early postoperative management after primary obstetric anal sphincter repair.
METHODS:
A total of 105 females were randomized after primary repair of a third-degree tear to receive lactulose (laxative group) or codeine phosphate (constipated group) for three days postoperatively. Patients were reviewed at three days and at three months postpartum. Recorded outcome measures were symptomatic and functional outcome and early postoperative morbidity.
RESULTS:
Forty-nine patients were randomly assigned to the constipated group and 56 patients to the laxative group. The first postoperative bowel motion occurred at a median of four (mean, 4.5 (range, 1–9)) days in the constipated group and at two (mean, 2.5 (range, 1–7)) days in the laxative group (P < 0.001). Patients in the constipated group had a significantly more painful first evacuation compared with the laxative group (P < 0.001). The mean duration of hospital stay was 3.7 (range, 2–6) days in the constipated group and 3.05 days in the laxative group (range, 2–5; P = 0.001). Nine patients in the constipated group complained of troublesome postoperative constipation compared with three in the laxative group (P = 0.033). Continence scores, anal manometry, and endoanal ultrasound findings were similar in the two groups at three months postpartum.
CONCLUSIONS:
Patients in the laxative group had a significantly earlier and less painful bowel motion and earlier postnatal discharge. There was no difference in the symptomatic or functional outcome of repair between the two regimens.
Presented at the meeting of the Society for Maternal-Fetal Medicine, San Francisco, California, February 2 to 7, 2003 相似文献
12.
Siproudhis L Eléouet M Rousselle A El Alaoui M Ropert A Bretagne JF 《Diseases of the colon and rectum》2008,51(9):1356-1360
PURPOSE Rectal prolapse is frequently associated with fecal incontinence; however, the relationship is questionable. The study was
designed to evaluate fecal incontinence in a large consecutive series of patients who suffered from rectal prolapse, focusing
on both past history, anal physiology, and imaging.
METHODS Eighty-eight consecutive patients who suffered from an overt rectal prolapse (72 women, 16 men; mean age, 51.1 ± 19.5 years)
as a main symptom were analyzed; 48 patients also experienced fecal incontinence compared with 40 without incontinence. Logistic
regression analyses were performed.
RESULTS The two groups of patients did not differ with respect to parity, weekly stool frequency, main duration of symptoms before
referral, occurrence of dyschezia, and digital help to defecate. Patients with prolapse who were older than 45 years (odds
ratio (OR), 4.51 (1.49–13.62); P = 0.007) and those with a past history of hemorrhoidectomy (OR, 9.05 (1.68–48.8); P = 0.01) were significantly more incontinent. Incontinent group showed frequent internal anal sphincter defect compared with
the continent group (60 vs. 6.2 percent; P = 0.0018).
CONCLUSIONS In patients with overt rectal prolapse, the occurrence of fecal incontinence needs special consideration for age and previous
hemorrhoid surgery as causative factors. Anal weakness and sphincter defects are frequently observed. 相似文献
13.
Effect of delivery on anal sphincter morphology and function 总被引:1,自引:1,他引:0
Jan Zetterström M.D. Anders Mellgren M.D. Ph.D. Linda L. Jensen R.N. W. Douglas Wong M.D. Don G. Kim M.D. Ann C. Lowry M.D. Robert D. Madoff M.D. Susan M. Congilosi M.D. 《Diseases of the colon and rectum》1999,42(10):1253-1260
PURPOSE: Anal sphincter injury is a serious complication of childbirth, which may result in persistent anal incontinence. Occult injuries, visualized with endoanal ultrasonography, have previously been reported in up to 35 percent of females in a British study. The aim of the present study was to study anal sphincter morphology and function before and after delivery in primiparous females in the United States. METHODS: Thirty-eight primiparous patients (mean age, 31 years) were evaluated with endoanal ultrasonography, anal manometry, and pudendal nerve terminal motor latency during pregnancy and after delivery. Bowel function before and after delivery was recorded according to set questionnaires. Cesarean section was performed in three patients. RESULTS: Clinical sphincter tears, requiring primary repair, occurred in 15 percent of the patients. After delivery endoanal ultrasonography revealed disruptions in the external anal sphincter in six patients, but no patient had disruption in the internal anal sphincter. One patient had slight scarring in the external sphincter. Of the seven patients with pathologic findings at endoanal ultrasonography, the left pudendal latency increased after delivery (P<0.05), and manometric results were reduced. Three of these seven patients had a third-degree or fourth-degree tear during delivery. All investigations were normal in the three patients who underwent cesarean section. CONCLUSIONS: The present study demonstrates a significant frequency of sphincter injuries (20 percent) after vaginal delivery. Obstetricians should be aware of this risk and explicitly inquire about incontinence symptoms at follow-up after delivery.Health East Foundation and Mead Johnson Pharmaceutical Inc. provided economic support, enabling participating volunteers to receive a stipend and baby supplies on completion of their tests.Dr. Mellgren was supported by grants from Health East Foundation and Karolinska Institutet Research Funds. Dr. Zetterström was supported by grants from Karolinska Institutet Research Funds.Read at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998. Poster presentation at the XVIIth Biennial Congress of the International Society Of University Colon and Rectal Surgeons, Malmö, Sweden, June 7 to 11, 1998. 相似文献
14.
Purpose This study was designed to evaluate the effects of caffeine on anorectal function by anorectal manometry.
Methods Ten healthy subjects were studied. They drank 200 ml of water and later 200 ml of a solution that contained caffeine 3.5 mg/kg
body weight. The anorectal manometric study was divided into three periods: basal, water, and caffeine; each period lasted
45 minutes.
Results After the ingestion of water, the basal anal sphincter pressure showed no change during the 45-minute recording, whereas after
caffeine consumption the basal anal sphincter pressure increased at 10 minutes (P = 0.047) and 15 minutes (P = 0.037). The average basal anal sphincter pressure throughout the 45 minutes was significantly higher after caffeine ingestion
than after water (P = 0.013). After caffeine intake, the maximum squeeze pressure increased significantly (P = 0.017) compared with the basal period. Both water and caffeine consumption caused a decrease in the rectal sensory threshold
for the desire to defecate.
Conclusions Caffeine 3.5 mg/kg body weight in 200 ml of water resulted in stronger anal sphincter contractions both at basal period and
during voluntary squeeze. The sensory threshold was also decreased, leading to an earlier desire to defecate. Caffeine consumption
may result in an earlier desire to defecate, leading to defecation if the anal sphincter can relax voluntarily. 相似文献
15.
Naimy N Lindam AT Bakka A Faerden AE Wiik P Carlsen E Nesheim BI 《Diseases of the colon and rectum》2007,50(12):2040-2046
Purpose This study was designed to evaluate the effect of biofeedback and electrostimulation in a randomized, clinical trial for the
treatment of patients with postdelivery anal incontinence.
Methods Forty-nine females who sustained third-degree or fourth-degree perineal rupture with a mean age of 36 (range, 22–44) years
were included in the study. The females were randomized to biofeedback or electrostimulation treatment. Forty females completed
the study: 19 in the biofeedback and 21 in the electrostimulation group. Biofeedback or electrostimulation sessions were performed
two times daily for eight weeks in each group. Wexner incontinence score, fecal incontinence quality of life scores, and reduced
quality of life on visual analog scale were registred before and after treatment. Patients’ self-rating of treatment effect
also was registered in both groups. The primary outcome measure was the Wexner incontinence score.
Results There were no differences in treatment effect between groups. Comparing pretreatment status to posttreatment in each group
showed no improvement in Wexner score, reduced quality of life, or any of the fecal incontinence quality of life scores. Patients’
self-rating of the treatment effect, however, showed a subjective improvement of symptoms both in the biofeedback and in the
electrostimulation group (median, 7 vs. 5.)
Conclusions This study shows that there was no difference in effect between biofeedback and electrostimulation. Neither biofeedback nor
electrostimulation treatments improved Wexner incontinence score, reduced quality of life, or fecal incontinence quality of
life scores. Both treatments resulted in improvement of patients’ subjective perception of incontinence control.
Read at the meeting of the Norwegian Surgical Society, Oslo, Norway, October 24 to 28, 2005. 相似文献
16.
Manometric squeeze pressure difference parallels functional outcome after overlapping sphincter reconstruction 总被引:2,自引:0,他引:2
Ha HT Fleshman JW Smith M Read TE Kodner IJ Birnbaum EH 《Diseases of the colon and rectum》2001,44(5):655-660
PURPOSE: This study was designed to evaluate the effectiveness of overlapping anal sphincter reconstruction and to determine the manometric parameters that correlate with a successful functional outcome. METHODS: A retrospective review of patients who had undergone overlapping sphincter reconstruction for anal incontinence from 1988 to 1999 was undertaken. Only patients with preoperative and six-months-postoperative anal manometry were included in this study. Standard statistical tests were used to compare pre- and postoperative findings. RESULTS: A total of 52 overlapping sphincter reconstructions were performed on 49 patients (46 females). The mean age was 44 (± standard error, 15.8; range, 20–81) years, with follow-up at six months. Forty-two patients had a history of complicated vaginal delivery (episiotomies, tears, forceps delivery); 36 patients had a history of anal or perineal surgery; and two patients had perianal Crohn's disease. Nine patients (17 percent) had undergone prior sphincter repair. Incontinence grade improved in 37 patients (71 percent), and complete continence returned in 21 patients (40 percent). The presence of a rectovaginal fistula, postoperative complications, previous sphincter repair, and increase in pudendal nerve terminal motor latency did not affect functional outcome (P = not significant). Patients older than 50 years had a better functional outcome than their younger counterparts after sphincter repair (P=0.02). Although mean maximal squeeze pressure and mean anal sphincter length increased significantly after sphincter reconstruction (P=0.0006 and 0.004, respectively), only squeeze pressure difference correlated with functional outcome (r=0.37;P=0.007). CONCLUSIONS: Overlapping sphincter reconstruction improved anal function in the majority of patients. The most important factor in the return to normal sphincter function is an increase in squeeze pressure. 相似文献
17.
Pascual M Pera M Courtier R Gil MJ Parés D Puig S Andreu M Grande L 《International journal of colorectal disease》2007,22(8):963-967
Background and aims Anorectal pressure studies have demonstrated internal anal sphincter (IAS) hypertonia in patients with chronic anal fissure.
It is unknown however, if these changes in IAS function are associated with any abnormality in sphincter morphology. The first
aim was to investigate the clinical characteristics and the manometric and endosonographic findings of the IAS in a cohort
of patients with chronic anal fissure. The second aim was to investigate the association between these findings and the outcome
with topical Glyceryl trinitrate (GTN) therapy.
Materials and methods All patients who presented with chronic anal fissure from November 1999 to May 2004 were included after failure of conservative
therapy. Anorectal manometry and anal endosonography were performed before treatment with 0.2% GTN ointment twice daily was
initiated. Patients were evaluated after 8 weeks.
Results One hundred and twenty-four patients (66 women, mean age, 45.2 ± 14.8 years) were included. Hypertonia of the IAS was found
in 84 (68%) patients. The mean maximum IAS thickness was 3.6 ± 0.76 mm (1.6–5.5). An abnormally thick IAS, adjusted by age,
was observed in 113 (91.1%) patients. We found no correlation between resting pressure and IAS thickness (r = 0.074; p = 0.41). At 8 weeks, 52 patients (42%) had healed with complete symptoms resolution. No statistically significant differences
were observed when clinical features and manometric and endosonographic findings were compared between healing and no-healing
fissures.
Conclusion The majority of patients with chronic anal fissure present an abnormally thick IAS. Clinical, manometric and endosonographic
features had no association with outcome after GTN treatment. 相似文献
18.
Forsgren C Zetterström J Lopez A Nordenstam J Anzen B Altman D 《Diseases of the colon and rectum》2007,50(8):1139-1145
Purpose This study was a prospective evaluation of the long-term effects of hysterectomy on bowel function using self-reported outcome
measures on symptoms of constipation, rectal emptying difficulties, and anal incontinence.
Methods In this prospective cohort study, 120 consecutive patients undergoing hysterectomy for benign conditions answered a questionnaire
on bowel habits and anorectal symptoms preoperatively. Forty-four patients underwent vaginal and 76 abdominal hysterectomy.
Follow-up was performed one and three years postoperatively. Data were analyzed by using multivariate regression and nonparametric
statistics.
Results The bowel and anorectal survey was answered by 115 of 120 patients (96 percent) after one year and 107 of 120 patients (89
percent) after three years. Abdominal hysterectomy was associated with increased anal incontinence symptoms at one-year (P < 0.01) and three-year follow-up (P < 0.01). Vaginal hysterectomy was not associated with increased anal incontinence symptoms at one year follow-up, although
there was a significant increase in incontinence symptoms at the three-year follow-up (P < 0.05). Risk factor analysis indicated that a reported history of obstetric sphincter injury was correlated to an increased
risk of developing posthysterectomy anal incontinence (odds ratio, 2.07; 95 percent confidence interval, 1.05–2.87; P < 0.05). There was no significant rise in constipation symptoms or rectal emptying difficulties in either cohort through
the follow-up.
Conclusions Neither abdominal nor vaginal hysterectomy was associated with constipation, aggravation of constipation, or rectal emptying
difficulties three years after surgery. Abdominal and vaginal hysterectomy was, however, associated with an increased risk
of mild anal incontinence symptoms, and patients with a reported history of obstetric sphincter injury were at particular
risk for posthysterectomy fecal incontinence.
Supported by funds from the Swedish Society of Medicine. 相似文献
19.
Tan E Anstee A Koh DM Gedroyc W Tekkis PP 《International journal of colorectal disease》2008,23(6):641-651
Objective This study aims to evaluate the diagnostic precision of endoanal magnetic resonance imaging in identifying anal sphincter
injury and/or atrophy when compared with either endoanal ultrasound or surgical diagnosis.
Materials and methods Quantitative meta-analysis was performed on nine studies, comparing endoanal MRI with endoanal ultrasound or surgical diagnosis
in 157 patients. Sensitivity, specificity, and diagnostic odds ratio were calculated for each study. Summary receiver operating
characteristic curves (SROC) and subgroup analysis were undertaken.
Results The overall sensitivity and specificity of endoanal MRI for external sphincter injury was 0.78 (95%CI: 0.66–0.84) and 0.66
(95%CI: 0.51–0.79), respectively. For internal sphincter injury detection, this was 0.63 (95%CI: 0.50–0.74) and 0.71 (95%CI:
0.60–0.81), respectively. For detection of atrophy, this was 0.86 (95%CI: 0.71–0.95) and 0.82 (95%CI: 0.65–0.93), respectively.
The area under the SROC curve and diagnostic odds ratio were 0.84 (SE = 0.07) and 6.14 (95%CI: 2.17–17.4) for external sphincter
injury, 0.79 (SE = 0.07) and 4.60 (95%CI: 1.75–12.15) for internal sphincter injury, and 0.92 (SE = 0.08) and 21.49 (95%CI:
2.87–160.64) for sphincter atrophy.
Conclusion Endoanal MRI was sensitive and specific for the detection of external sphincter injury and especially sphincter atrophy. It
may be useful as an alternative to endoanal ultrasound in patients presenting with fecal incontinence, although further clinical
studies are needed to identify its best application in clinical practice. 相似文献
20.
De Nardi P Corsetti M Passaretti S Squillante S Castellaneta AG Staudacher C Testoni PA 《Diseases of the colon and rectum》2008,51(8):1255-1260
Purpose Stapled hemorrhoidopexy is designed to replace the hemorrhoids into the anal canal by excising the redundant rectal mucosa
above the anorectal ring, thus resulting in an intrarectal suture. Few studies have evaluated rectal function after this procedure.
This prospective study was designed to use the electronic barostat to assess whether rectal motor and sensory functions change
after stapled hemorrhoidopexy.
Methods Ten patients (4 women, mean age, 46 ± 9 years) with third-degree and fourth-degree hemorrhoids who underwent stapled hemorrhoidopexy
were studied. One week before and six months after surgery, they underwent three different rectal distensions (pressure-controlled
stepwise, volume-controlled stepwise, and ramp) controlled by an electronic barostat.
Results Rectal distensibility was significantly lower after surgery during pressure stepwise (P = 0.01), during volume stepwise (P = 0.006), and during ramp distension (P = 0.001). Volume thresholds for desire to defecate, urgency, and discomfort were significantly lower after surgery during
all three distensions (P < 0.05). Volume threshold for first perception also was significantly lower after surgery during volume ramp distension (P = 0.01).
Conclusions Rectal distensibility and volume thresholds for sensations decrease after stapled hemorrhoidopexy. These impairments persist
for at least six months after surgery.
Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6,
2007. 相似文献