CAJ | 학술논문

目的评价臀大肌瓣转移肛提肌加强术治疗肛门直肠畸形术后排便功能障碍的恢复情况.方法选择28例先天性肛门闭锁术后排便功能障碍的患儿,年龄4～14岁,男19例,女9例,单纯肛提肌功能不良的18例,肛提肌和肛门外括约肌功能均不良的10例,全部行臀大肌瓣转移肛提肌加强术,术前均行盆底肌MRI、钡灌肠及臀大肌肌电图检查,手术前后均行结肠传输试验、肛门直肠测压和排便功能评分.术后对患儿进行6～48个月的随访,平均24个月.结果 28例手术患儿中26例获得随访,术前臀大肌肌电图均显示臀大肌功能良好,钡灌肠显示直肠无扩张,结肠传输试验表现为出口梗阻,盆底肌MRI见28例患儿肛提肌发育薄弱或不对称,排便功能评分结果示28例患儿均差.肛管静息压手术前后分别为(16.77±4.25) mmHg和(18.67±4.48)mmHg、肛管最大收缩压在手术前后分别为(61.05±14.37) mmHg和(72.12±16.76)mmHg,差异均无统计学意义(P＞0.05),术后单纯肛提肌功能不良的排便功能评分达优6例,良10例,肛提肌和肛门外括约肌功能均不良的排便功能评分优0例,良2例,差8例.优良率占69.23％.结论对于肛提肌功能不全所导致的排便功能障碍,行臀大肌瓣转移肛提肌加强术可改善排便功能,部分括约肌功能不良的患儿术后可能失禁不能改善或者加重,需要进一步的手术或训练治疗.
목적 평개둔대기판전이항제기가강술치료항문직장기형술후배편공능장애적회복정황.방법 선택28례선천성항문폐쇄술후배편공능장애적환인,년령4～14세,남19례,녀9례,단순항제기공능불량적18례,항제기화항문외괄약기공능균불량적10례,전부행둔대기판전이항제기가강술,술전균행분저기MRI、패관장급둔대기기전도검사,수술전후균행결장전수시험、항문직장측압화배편공능평분.술후대환인진행6～48개월적수방,평균24개월.결과 28례수술환인중26례획득수방,술전둔대기기전도균현시둔대기공능량호,패관장현시직장무확장,결장전수시험표현위출구경조,분저기MRI견28례환인항제기발육박약혹불대칭,배편공능평분결과시28례환인균차.항관정식압수술전후분별위(16.77±4.25) mmHg화(18.67±4.48)mmHg、항관최대수축압재수술전후분별위(61.05±14.37) mmHg화(72.12±16.76)mmHg,차이균무통계학의의(P＞0.05),술후단순항제기공능불량적배편공능평분체우6례,량10례,항제기화항문외괄약기공능균불량적배편공능평분우0례,량2례,차8례.우량솔점69.23％.결론 대우항제기공능불전소도치적배편공능장애,행둔대기판전이항제기가강술가개선배편공능,부분괄약기공능불량적환인술후가능실금불능개선혹자가중,수요진일보적수술혹훈련치료.
Objective To evaluate the effect of gluteus maximus flap transplantation to reinforce levator ani for the anorectal dysfunction after previous anorectal malformation operation. Methods Twenty eight children aged 4-14 years old, including 19 boys and 9 girls, were enrolled in this study. All the children suffered from anorectal dysfunction after previous operations for congenital anal atresia. Among them, 18 patients had levator ani muscle dysfunction, while the other 10 had levator ani muscle and anal sphincter dysfunction. All subjects received examinations including pelvic floor MR, barium enema and gluteus maximus electromyography. All patients underwent gluteus maximus flap transplantation to reinforce levator ani. Colonic transit testing, anorectal pressure and defecation score were also studied to evaluate the surgical efficacy. The patients were followed up for 4-48 months, with an average of 24 months. Results Twenty six patients were followed up after surgery. Before surgery, gluteus maximus electromyography and barium enema revealed normal muscle function and bowel movement. Colonic transit testing showed outlet obstruction. Pelvic floor MR revealed levator ani muscle complex was poorly developed and asymmetric. All 28 patients' defecation function was scored as poor before operation. After surgery, 69.23％ patients achieved excellent and good defecation function. Among the patients with levator ani muscle dysfunction, 6 patients' defecation were scored excellent and 10 were good. However, among the patients with levator ani muscle and anal sphincter dysfunction, 2 patients' defecation function was scored good while the other 8 were poor. Conclusions Gluteus maximus flap transplantation to reinforce levator ani is safe and effective to treat anorectal dysfunction in patients with previous anorectal malformation operation.