摘要
目的比较不同股薄肌环绕法对股薄肌移植并括约肌成形术治疗先天性肛门畸形成形术后失禁患者的肛门功能。方法回顾性分析2009年1月至2012年1月间天津医科大学第二医院及天津市人民医院采用股薄肌移植并括约肌成形术治疗的38例先天性肛门畸形成形术后肛门失禁患者的临床资料，其中U形环绕组（股薄肌从肛门后绕肛管近1周缝合到同侧耻骨梳韧带）20例，1形环绕组（股薄肌从肛门前绕肛管1周缝合到对侧坐骨结节骨膜或耻骨梳韧带上）18例。比较两组患者术前、术后2周、6月、1年和2年的肛门失禁Wexner评分与肛门直肠测压结果，以及术后蹲位排粪困难的发生情况。结果u形环绕组和1形环绕组患者术后Wexner评分、肛管静息压、最大收缩压、持续收缩时间和排粪阈值均随着时间的推移而逐渐改善（均P=0．000）；但两组间上述指标的差异均无统计学差异（均P〉0．05）。术后2周、6月、1年和2年两组分别有4例（20．0％）、3例（15．0％）、2例（10．0％）、1例（5．0％）和10例（55．6％）、12例（66．7％）、10例（55．6％）、8例（44．4％）患者出现蹲位排粪困难，U形环绕组的比例较1形环绕组明显减少（P=O．002），但两组患者蹲位排便困难的比例并未随时间的推移而明显变化（P．0．057）。结论股薄肌U形环绕与γ0环绕的股薄肌移植并括约肌成形术均可以改善患者的肛门功能，但U形环绕法能降低患者术后蹲位排粪困难的发生率．值得临床推广应用．
Objective To compare the clinical effect of graciloplasty using two different gracilis encircled loops and to research the better method for the treatment of fecal incontinence after anoplasty for imperforate anus. Methods Clinical data of 38 incontinence patients with congenital anal malformation undergoing graciloplasty in our hospitals from January 2009 to January 2012 were retrospectively analyzed. Twenty patients received the modified surgery in which the gracilis muscle was transposed anticlockwise into a circum-anal tunnel with a U-loop and its tendon secured to the ipsilateral pectineal ligament. Eighteen patients received the traditional surgery in which the gracilis muscle was wrapped clockwise around the anus with a γ-loop and its tendon secured to the contralateral periosteum of ischial tuberosity or pectineal ligament. All the patients were evaluated via Wexner score and anal manometry before surgery and 2 weeks, 6 months, 1 year and 2 years after surgery. In addition, it was assessed whether the patients had difficulty defecating while squatting after surgery. Results Generalized estimating equations showed that the Wexner score in two groups gradually decreased after surgery （P=0.000）, but there was no significant difference between two groups （P= 0.554）. At 2 weeks, 6 months, 1 year and 2 years after surgery, there were respectively 4 cases （20.0%）, 3 cases （15.0%）, 2 cases （10.0%）, 1 case （5.0%）, who showed squatting difficult defecation in the U-loop group, and 10 cases（55.6%）, 12 cases（66.7%）, 10 cases （55.6%）, 8 cases （44.4%） in the γ-loop group. The probability of squatting difficult defecation in U-loop group was significantly lower compared to γ-loop group （P=0.002）, but the probability of squatting difficult defecation in two groups did not obviously change with time （P=0.057）. Repeated measures ANOVA showed that anal resting pressure, anal maximal squeeze pressure, duration of anal squeeze, and rectal maximum tolerable volume in two groups were gradually improved after surgery （all P〈0.01 ）, but there were no significant differences between two groups （all P〉0.05）. Conclusions Graciloplasty with different gracilis loops can improve anal function. However, U-loop can better improve difficuh defecating while squatting, and is worthwhile for spreading in clinical practice.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2015年第7期693-697,共5页
Chinese Journal of Gastrointestinal Surgery
基金
天津市卫生局科技基金项目（2013KZ107）
