中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2013年
12期
896-899
,共4页
孙小兵%孙小刚%王若义%李金良
孫小兵%孫小剛%王若義%李金良
손소병%손소강%왕약의%리금량
消化系统畸形%排便%功能恢复
消化繫統畸形%排便%功能恢複
소화계통기형%배편%공능회복
Digestive system abnormalities%Defecation%Recovery of function
目的 探讨肛门直肠畸形术后排便障碍患儿肛提肌的形态学变化及肛提肌成形术治疗排便障碍的早期临床结果.方法 回顾性分析2006年11月至2011年2月间肛门直肠畸形术后大便失禁患儿32例的临床资料.男21例,女11例;年龄4～13岁,均同时合并排便困难,无肛门狭窄及直肠扩张,全部病例行盆腔MRI检查,于轴位、矢状位和冠状位对肛提肌进行观察,同时行肛肠测压和结肠传输试验.30例排泄分数＜80％,传输指数＞50％.临床评分良11例,差21例.全部患儿利用转移的臀大肌瓣行肛提肌成形,术后随访6个月～1年,26例行肛肠测压,21例行结肠传输实验及全部病例行肛门功能临床评价.结果 盆底肌MRI显示肛提肌变薄、不完整及下塌.术后6个月～1年,24例排便功能改善,15例结肠传输试验排泄分数＞80％.临床评分9例为优,15例为良,8例为差.结论 肛提肌发育不良可能是肛门直肠畸形术后排便障碍的重要原因之一,利用转移的臀大肌瓣行肛提肌成形术可改善患儿的排便功能.
目的 探討肛門直腸畸形術後排便障礙患兒肛提肌的形態學變化及肛提肌成形術治療排便障礙的早期臨床結果.方法 迴顧性分析2006年11月至2011年2月間肛門直腸畸形術後大便失禁患兒32例的臨床資料.男21例,女11例;年齡4～13歲,均同時閤併排便睏難,無肛門狹窄及直腸擴張,全部病例行盆腔MRI檢查,于軸位、矢狀位和冠狀位對肛提肌進行觀察,同時行肛腸測壓和結腸傳輸試驗.30例排洩分數＜80％,傳輸指數＞50％.臨床評分良11例,差21例.全部患兒利用轉移的臀大肌瓣行肛提肌成形,術後隨訪6箇月～1年,26例行肛腸測壓,21例行結腸傳輸實驗及全部病例行肛門功能臨床評價.結果 盆底肌MRI顯示肛提肌變薄、不完整及下塌.術後6箇月～1年,24例排便功能改善,15例結腸傳輸試驗排洩分數＞80％.臨床評分9例為優,15例為良,8例為差.結論 肛提肌髮育不良可能是肛門直腸畸形術後排便障礙的重要原因之一,利用轉移的臀大肌瓣行肛提肌成形術可改善患兒的排便功能.
목적 탐토항문직장기형술후배편장애환인항제기적형태학변화급항제기성형술치료배편장애적조기림상결과.방법 회고성분석2006년11월지2011년2월간항문직장기형술후대편실금환인32례적림상자료.남21례,녀11례;년령4～13세,균동시합병배편곤난,무항문협착급직장확장,전부병례행분강MRI검사,우축위、시상위화관상위대항제기진행관찰,동시행항장측압화결장전수시험.30례배설분수＜80％,전수지수＞50％.림상평분량11례,차21례.전부환인이용전이적둔대기판행항제기성형,술후수방6개월～1년,26례행항장측압,21례행결장전수실험급전부병례행항문공능림상평개.결과 분저기MRI현시항제기변박、불완정급하탑.술후6개월～1년,24례배편공능개선,15례결장전수시험배설분수＞80％.림상평분9례위우,15례위량,8례위차.결론 항제기발육불량가능시항문직장기형술후배편장애적중요원인지일,이용전이적둔대기판행항제기성형술가개선환인적배편공능.
Objective To evaluate the MRI morphology of the ani lavator of children with defecation disorder after anoplasty for anorectal malformation and to present early results of levatorplasties.Methods Thirty-two children (male 21,female 11 ; age 4-13 years old) with anorectal malformation who developed fecal incontinence after anoplasty were hospitalized from Nov.2006 to Feb.2011.All patients were complicated with constipation without anus strincture and rectum dilation.Manometry,colon transit test and pelvic floor MRI were performed.Colon transit test indicated that excretion score was ＜80％ and transmission index was ＞50％ in 30 patients.Clinical score was fair in 11 patients and poor in 21 patients.The gluteus maximus flap transplantation was performed to reinforce the ani levator for all patients.Twenty-six patients underwent anal manometry 6 months to 1 year after operation.Colon transit test were performed on 21 patients.Results Pelvic floor MRI indicated weak ani levator.Defecation was improved in 24 patients 6 months to 1 year after operation.Excretion score was more than 80％ in 15 patients.Clinical score was good in 9 patients,fair in 15 patients and poor in 8 patients.Conclusions Ani levator dysplasia may be an important cause of defecation disorder for children with anorectal malformation.Levatorplasties using transplantated gluteus maximus flap can improve defecation.
