股薄肌成形术联合排便训练治疗患儿大便失禁

目的总结股薄肌成形术联合肛门排便训练治疗患儿大便失禁的操作经验和远期疗效。方法回顾性分析1996年4月-2011年4月本院收治的23例行股薄肌成形术联合术后排便训练的大便失禁患儿病例资料。其中男14例,女9例;初发19例,复发4例。先天性无肛行肛门成形术14例,先天性巨结肠术后大便失禁7例,外伤2例。大便失禁患儿分为3组,其中完全失禁6例,稀便失禁8例,肛周污便9例。23例患儿均进行了股薄肌成形术并术后肛门排便训练。术后定期随访,分别测量术前和术后2周、6个月和2 a各组患儿的肛门静息压和最大收缩压,并用SPSS 13.0统计学软件进行对比分析。结果 23例患儿均成功实施了股薄肌成形术,并坚持术后的排便训练,术后通过2～14 a随访,主观症状效果明显满意者13例,有效7例,完全无效者3例,满意率达86.95%(20/23例)。各组患者术后肛门静息压和最大收缩压较术前均有明显改善(Pa<0.05),经过肛门排便训练2 a后测值较术后早期有明显改善(P<0.05)。结论股薄肌成形术联合术后肛门排便训练能够有效改善小儿大便失禁的症状和生活质量。实用儿科临床杂志,2012,27(6):465-466,472

Efficiency of Graciloplasty Combined with Bowel Training Therapy for Fecal Incontinence in Children

Objective To investigate the operating experience and long-term clinical efficiency of fecal incontinence treated by graciloplasty combined with bowel training in children.Methods From Apr.1996 to Apr.2011,the data of 23 patients with fecal incontinence who underwent graciloplasty combined with bowel training were analyzed retrospectively.Among 23 cases,14 cases were male and 9 cases were female,in which 19 patients were first occurrence while 4 cases were recurrent.Fourteen cases occurred in imperforate anus postoperative,7 cases occurred in Hirschsprung postoperative,and 2 cases occurred in the following trauma.Twenty-three patients were divided into 3 groups,with complete incontinence in 6 cases,loose stools incontinence in 8 cases and perianal sewage in 9 cases.All patients were treated with graciloplasty and bowel training.Anal canal resting pressure and squeeze pressure were measured preoperative and postoperative in 2 weeks,6 months and 2 years.Results Twenty-three patients were successfully treated by graciloplasty combined with bowel training.Among the 23 patients,who were all followed up for 2-14 years,defecation control function was excellent in 13 cases,fine in 7 cases and invalid in 3 cases.Satisfactory rate was 86.95 %(20/23 cases),anal canal resting pressure and squeeze pressure of each group were significantly improved compared with preoperative period(P<0.05).After 2 years of bowel training,the measured values were significantly improved compared with the early postoperative period(P<0.05).Conclusion Graciloplasty combined with bowel training therapy is an effective method to treat fecal incontinence in children.