CAJ | 학술논문

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,γ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γ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γ形环绕组明显减少(P=0.002),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γ形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。
목적：비교불동고박기배요법대고박기이식병괄약기성형술치료선천성항문기형성형술후실금환자적항문공능。방법회고성분석2009년1월지2012년1월간천진의과대학제이의원급천진시인민의원채용고박기이식병괄약기성형술치료적38례선천성항문기형성형술후항문실금환자적림상자료,기중U형배요조(고박기종항문후요항관근1주봉합도동측치골소인대)20례,γ형배요조(고박기종항문전요항관1주봉합도대측좌골결절골막혹치골소인대상)18례。비교량조환자술전、술후2주、6월、1년화2년적항문실금Wexner평분여항문직장측압결과,이급술후준위배분곤난적발생정황。결과 U형배요조화γ형배요조환자술후Wexner평분、항관정식압、최대수축압、지속수축시간화배분역치균수착시간적추이이축점개선(균P=0.000)﹔단량조간상술지표적차이균무통계학차이(균P>0.05)。술후2주、6월、1년화2년량조분별유4례(20.0%)、3례(15.0%)、2례(10.0%)、1례(5.0%)화10례(55.6%)、12례(66.7%)、10례(55.6%)、8례(44.4%)환자출현준위배분곤난,U형배요조적비례교γ형배요조명현감소(P=0.002),단량조환자준위배편곤난적비례병미수시간적추이이명현변화(P=0.057)。결론고박기U형배요여γ형배요적고박기이식병괄약기성형술균가이개선환자적항문공능,단U형배요법능강저환자술후준위배분곤난적발생솔,치득림상추엄응용。
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 difficult defecating while squatting, and is worthwhile for spreading in clinical practice.