改良股薄肌转移代外括约肌行肛门重建治疗肛门闭锁术后大便失禁

目的 评估改良股薄肌转移代肛门外括约肌重建术治疗肛门闭锁术后大便失禁的临床效果.方法 回顾性分析自2003年8月至2012年8月于山东大学第二医院小儿外科收治的31名行改良股薄肌代肛门外括约肌治疗大便失禁患儿的病例资料,围绕术前及术后大便临床表现进行病历分析.并依据术前倒立位腹部平片显示的闭锁程度将入选病例分为三组.所有入选病例的手术前、后临床表现均采用克利夫兰大便失禁程度评分系统进行评分并分级.按照其资料的分布及性质,手术前后的比较依据正态性分布情况选用配对t检验或者非参数检验,组间的比较采用依据正态性分布情况和方差齐性选用成组设计方差分析,两两比较采用LSD方法.结果 入选病例术后随访6～87个月,平均33.9个月,22例患儿获得大便排放的自主性控制,大便失禁评分明显降低,与术前相比差异具有统计学意义;肛门直肠测压结果显示肛管最大收缩压及肛管静息压明显增加,手术前后差异具有统计学差异;直肠静息压手术前后未见明显变化,差异无明显统计学意义.结论 改良股薄肌转移代肛门外扩约肌通过提高肛管收缩压及肛管静息压以维持肛管的严密闭合达到大便排放的自主控制,是治疗肛门闭锁术后大便失禁的有效方法.

Ameliorated graciloplasty anorectal reconstruction for fecal incontinince after anoplasty of anal atresia

Objective To evaluate the efficacies of ameliorated graciloplasty anorectal reconstruction for fecal incontinence after anoplasty of anal atresia.Methods The clinical data were retrospectively analyzed for 31 patients undergoing ameliorated graciloplasty anorectal reconstruction between August 2003 and August 2011 at Department of Pediatric Surgery,Second Hospital,Shandong University.They were divided into 3 groups according to the findings of preoperative abdominal radiography.And their perioperative fecal profiles were recorded and analyzed.All of them were scored and graded by the Cleveland Fecal Incontinence Degree Grading System.Results During a mean follow-up period of 33.9 (6-87) months,the postoperative scores of 22 patients decreased significantly.Anorectal tube and anal canal resting pressures had statistical significant differences.After a transplantation of gracilis muscle,there was no significant change of anal canal pressure.Conclusions Ameliorated graciloplasty of anorectal reconstruction may restore anal canal pressure for curing fecal incontinence after anoplasty of anal atresia.