臀大肌代肛門括約肌治療高位無肛術后大便失禁_《中國修復重建外科雜志》

作者：

孔飛騰 ¹ , 李福玉 ¹ , 劉菊先 ² , 陳詠梅 ¹ , 吳楊 ¹ , 楊曉東 ¹ , 向波 ¹

四川大學華西醫院（成都，610041） 1 小兒外科，2 超聲診斷科;

關鍵詞：

臀大肌肛門括約肌高位無肛大便失禁

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目的探討臀大肌代肛門括約肌控便手術治療高位無肛術后大便失禁的療效。方法 2002 年12 月－
2010 年11 月，收治25 例高位無肛行腹會陰聯合肛門成形術后完全性大便失禁患者，采用臀大肌代肛門括約肌控便手術
治療。男11 例，女14 例；年齡3 ～ 22 歲，平均10.2 歲。術前直腸造影、肛管直腸測壓及肌電圖檢查顯示肛門括約肌功能
缺失或嚴重不良。采用Wexner 評分、大便失禁生活質量調查問卷（FIQL）、自測健康評定量表（SRHMS）評定患者生活質
量，并行肛管直腸測壓、肛管直腸腔內超聲檢查、動態排便造影檢查。結果術后1 周2 例患者發生直腸切口瘺，其余
患者切口Ⅰ期愈合。患者均獲隨訪，隨訪時間1 ～ 9 年，平均6.3 年。大便次數由術前每天10 余次減少至4 ～ 6 次。術
后1 年及術后2 年及以上Wexner 評分及SRHMS 自測評分與術前比較，差異均有統計學意義（P lt; 0.05）；術后2 年及以
上FIQL 評分較術前及術后1 年明顯改善（P lt; 0.05）。肛管直腸測壓結果示術后2 年及以上患者肛管最大收縮壓、收縮持
續時間及最大收縮容積較術前及術后1 年明顯提高，差異有統計學意義（P lt; 0.05）。結論臀大肌代肛門括約肌手術
能一定程度改善高位無肛術后大便失禁患者的控便能力。

引用本文： 孔飛騰 ,李福玉,劉菊先,陳詠梅,吳楊,楊曉東,向波. 臀大肌代肛門括約肌治療高位無肛術后大便失禁. 中國修復重建外科雜志, 2012, 26(5): 571-575. doi: 復制

1.	Peña A. Surgical management of anorectal malformations: a unified concept. Pediatr Surg Int, 1988, 3(2-3): 82-93.
2.	Hamid CH, Holland AJ, Martin HC. Long-term outcome of anorectal malformations: the patient perspective. Pediatr Surg Int, 2007, 23(2): 97-102.
3.	Aliev EA. Surgical treatment of anal sphincter insufficiency using the flaps of the gluteus maximus muscle. Klin Khir, 2010, (6): 46-49.
4.	Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1): 77-97.
5.	Rockwood TH, Church JM, Fleshman JW, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum, 2000, 43(1): 9-16.
6.	許軍, 王斌會, 胡敏燕, 等. 自測健康評定量表的研制與考評. 中國行為醫學科學, 2000, 9(1): 65-68.
7.	Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology, 2006, 130(5): 1527-1537.
8.	白玉作, 王維林, 王慧貞, 等. 小兒肛門直腸畸形術后遠期生活質量的初步研究. 中華小兒外科雜志, 1999, 20(5): 263-266.
9.	Hartman EE, Qort FJ, Aronson DC, et al. Quality of life and disease-specific functioning of patients with anorectal malformations or Hirschsprung’s disease: a review. Arch Dis Child, 2011, 96(4): 398-406.
10.	Rajindrajith S, Devanarayana NM, Benninga MA. Constipation-associated and nonretentive fecal incontinence in children and adolescents: an epidemiological survey in Sri Lanka. J Pediatr Gastroenterol Nutr, 2010, 51(4): 472-476.
11.	Grasshoff-Derr S, Backhaus K, Hubert D, et al. A successful treatment strategy in infants and adolescents with anorectal malformation and incontinence with combined hydrocolonic ultrasound and bowel management. Pediatr Surg Int, 2011, 27(10): 1099-1103.
12.	Danielson J, Karlbom U, Graf W, et al. Long-term outcome after free autogenous muscle transplantation for anal incontinence in children with anorectal malformations. J Pediatr Surg, 2010, 45(10): 2036-2040.
13.	Shafik A, Olfat El Sibai, Shafik AA, et al. Contraction of gluteal maximus muscle on increase of intra-abdominal pressure: role in the fecal continence mechanism. Surg Innov, 2007, 14(4): 270-274.
14.	陳姬, 李福玉, 劉利君, 等. 兒童臀大肌下部肌瓣轉位重建肛門外括約肌的應用解剖. 解剖與臨床, 2007, 12(4): 243-245, 249.
15.	Cera SM, Wexner SD. Muscle transposition: does it still have a role? Clin Colon Rectal Surg, 2005, 18(1): 46-54.
16.	張震, 吳曄明. 先天性肛門直腸畸形術后排便功能評估標準. 臨床小兒外科雜志, 2008, 7(4): 52-54, 63.
17.	Hancock BD, Smith K. The internal sphincter and Lord’s procedure for haemorrhoids. Br J Surg, 1975, 62(10): 833-836.

1. Peña A. Surgical management of anorectal malformations: a unified concept. Pediatr Surg Int, 1988, 3(2-3): 82-93.
2. Hamid CH, Holland AJ, Martin HC. Long-term outcome of anorectal malformations: the patient perspective. Pediatr Surg Int, 2007, 23(2): 97-102.
3. Aliev EA. Surgical treatment of anal sphincter insufficiency using the flaps of the gluteus maximus muscle. Klin Khir, 2010, (6): 46-49.
4. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1): 77-97.
5. Rockwood TH, Church JM, Fleshman JW, et al. Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum, 2000, 43(1): 9-16.
6. 許軍, 王斌會, 胡敏燕, 等. 自測健康評定量表的研制與考評. 中國行為醫學科學, 2000, 9(1): 65-68.
7. Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology, 2006, 130(5): 1527-1537.
8. 白玉作, 王維林, 王慧貞, 等. 小兒肛門直腸畸形術后遠期生活質量的初步研究. 中華小兒外科雜志, 1999, 20(5): 263-266.
9. Hartman EE, Qort FJ, Aronson DC, et al. Quality of life and disease-specific functioning of patients with anorectal malformations or Hirschsprung’s disease: a review. Arch Dis Child, 2011, 96(4): 398-406.
10. Rajindrajith S, Devanarayana NM, Benninga MA. Constipation-associated and nonretentive fecal incontinence in children and adolescents: an epidemiological survey in Sri Lanka. J Pediatr Gastroenterol Nutr, 2010, 51(4): 472-476.
11. Grasshoff-Derr S, Backhaus K, Hubert D, et al. A successful treatment strategy in infants and adolescents with anorectal malformation and incontinence with combined hydrocolonic ultrasound and bowel management. Pediatr Surg Int, 2011, 27(10): 1099-1103.
12. Danielson J, Karlbom U, Graf W, et al. Long-term outcome after free autogenous muscle transplantation for anal incontinence in children with anorectal malformations. J Pediatr Surg, 2010, 45(10): 2036-2040.
13. Shafik A, Olfat El Sibai, Shafik AA, et al. Contraction of gluteal maximus muscle on increase of intra-abdominal pressure: role in the fecal continence mechanism. Surg Innov, 2007, 14(4): 270-274.
14. 陳姬, 李福玉, 劉利君, 等. 兒童臀大肌下部肌瓣轉位重建肛門外括約肌的應用解剖. 解剖與臨床, 2007, 12(4): 243-245, 249.
15. Cera SM, Wexner SD. Muscle transposition: does it still have a role? Clin Colon Rectal Surg, 2005, 18(1): 46-54.
16. 張震, 吳曄明. 先天性肛門直腸畸形術后排便功能評估標準. 臨床小兒外科雜志, 2008, 7(4): 52-54, 63.
17. Hancock BD, Smith K. The internal sphincter and Lord’s procedure for haemorrhoids. Br J Surg, 1975, 62(10): 833-836.

《中國修復重建外科雜志》

臀大肌代肛門括約肌治療高位無肛術后大便失禁

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《中國修復重建外科雜志》

臀大肌代肛門括約肌治療高位無肛術后大便失禁

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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