CAJ | 학술논문

目的探讨臀大肌瓣移位肛提肌加强术在治疗儿童神经源性大便失禁中的作用.方法 2006年1月至2009年12月在我院行臀大肌瓣移位肛提肌加强术13例,其中男9例,女4例,手术年龄7～16岁,平均13.2岁,患儿术前均有明确的脊髓拴系松解手术史,在手术前均行盆底肌电图检查、盆底肌MR、结肠传输试验检查,严格掌握手术适应证,手术前后均行肛门直肠测压、临床疗效评价.结果术后12例患儿获得随访,术前盆底肌电图均表现为神经源性损害,且为失代偿期.结肠传输试验表现为混合型10例,出口梗阻型3例,盆底肌MR见13例患儿肛提肌发育不对称或肛提肌不能清楚显示,肛门直肠测压手术前后均未见明显变化,临床评分结果示13例患儿均表现为完全性大便失禁,评分差,术后患儿的临床表现优0例,良8例,差4例.结论臀大肌瓣移位肛提肌加强术有利于改善神经源性大便失禁的排便状况.
목적 탐토둔대기판이위항제기가강술재치료인동신경원성대편실금중적작용.방법 2006년1월지2009년12월재아원행둔대기판이위항제기가강술13례,기중남9례,녀4례,수술년령7～16세,평균13.2세,환인술전균유명학적척수전계송해수술사,재수술전균행분저기전도검사、분저기MR、결장전수시험검사,엄격장악수술괄응증,수술전후균행항문직장측압、림상료효평개.결과 술후12례환인획득수방,술전분저기전도균표현위신경원성손해,차위실대상기.결장전수시험표현위혼합형10례,출구경조형3례,분저기MR견13례환인항제기발육불대칭혹항제기불능청초현시,항문직장측압수술전후균미견명현변화,림상평분결과시13례환인균표현위완전성대편실금,평분차,술후환인적림상표현우0례,량8례,차4례.결론 둔대기판이위항제기가강술유리우개선신경원성대편실금적배편상황.
Objective To study the efficacy of gluteus maximus flap transposition for the treatment of neurogenic fecal incontinence in children.Methods Between January 2006 and December 2009,7 males and 4 females were diagnosed with neurogenic fecal incontinence and underwent surgery at this center.Their age ranged from 7 to 16 years old (mean age,13.2 years).All the children had a history of tethered spinal cord release surgery.Before surgery,all patients had pelvic floor electromyography,colonic transit test,anorectal manometry,and pelvic floor MRI.The patients were followed up after surgery.The clinical data were retrospectively analyzed to evaluate the efficacy of the surgery.Results Pelvic floor electromyography found the uncompensated nerve function impairment before surgery.Colonic transit test found 10 patients had neurogenic fecal incontinence,and 3 had outlet obstruction.Anorectal manometry measurements of these patients didn't have any changes after surgery.The anorectal function was scored fair on 8 patients,and poor on 4.Conclusions Gluteus maximus flap transposition is effective to improve the anorectal function on the patients with neurogenic fecal incontinence.