改良股薄肌移植肛门成形术治疗小儿肛门闭锁术后大便失禁的临床效果
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摘要
目的探讨改良股薄肌移植肛门成形术治疗小儿肛门闭锁术后大便失禁的临床效果。方法对2015年8月—2016年8月收治的15例高位肛门闭锁腹会阴肛门成形术后出现重度大便失禁的患儿实施改良股薄肌移植肛门成形术。术前及术后1个月、3个月、6个月行肛门功能临床评分及肛管直肠测压,按其资料的分布及性质选用方差分析,两两比较采用Bonferroni检验。结果 15例手术均成功,术后大便失禁程度减轻,肛门功能临床评分及肛管直肠测压手术前后差异有统计学意义(P<0.05)。结论改良股薄肌移植肛门成形术治疗小儿高位肛门闭锁术后大便失禁是一种较为有效的方法。
Objective To explore the efficacies of ameliorated graciloplasty anorectal reconstruction for fecal incontinence after anoplasty of pediatric anal atresia. Methods The clinical data were analyzed for 15 patients undergoing ameliorated graciloplasty anorectal reconstruction for seriously fecal incontinince after anoplasty of high anal atresia between August 2015 and August 2016. And their preoperative and postoperative 1 month,3 months,6 months fecal profiles and anorectal manometry were recorded and analyzed. According to the data distribution and properties of the selection of variance analysis,pairwise comparison using the Bonferroni test. Results Totally 15 cases of surgery are performed successfully,the degree of postoperative fecal incontinence has improved,fecal profiles and anorectal manometry had statistical significant differences. Conclusion Ameliorated graciloplasty anorectal reconstruction for fecal incontinince after anoplasty of pediatric anal atresia is a more effective method.
Objective To explore the efficacies of ameliorated graciloplasty anorectal reconstruction for fecal incontinence after anoplasty of pediatric anal atresia. Methods The clinical data were analyzed for 15 patients undergoing ameliorated graciloplasty anorectal reconstruction for seriously fecal incontinince after anoplasty of high anal atresia between August 2015 and August 2016. And their preoperative and postoperative 1 month,3 months,6 months fecal profiles and anorectal manometry were recorded and analyzed. According to the data distribution and properties of the selection of variance analysis,pairwise comparison using the Bonferroni test. Results Totally 15 cases of surgery are performed successfully,the degree of postoperative fecal incontinence has improved,fecal profiles and anorectal manometry had statistical significant differences. Conclusion Ameliorated graciloplasty anorectal reconstruction for fecal incontinince after anoplasty of pediatric anal atresia is a more effective method.
引文
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[3]张曦,岳峰,张焱,等.全反式维甲酸致先天性肛门直肠畸形胎鼠盆底肌肌肉、神经发育的形态学研究[J].宁夏医学杂志,2014,36(4):289-291,插1.
[4]张曦,罗靖侠,岳峰,等.PGP9.5、SYn和α-actin在先天性肛门直肠畸形动物模型盆底肌的表达及意义[J].宁夏医学杂志,2015,37(2):97-100,插1.
[5]高明娟,刘远梅,毛羽晨,等.NGF及其受体Trk A、P75 NTR在先天性肛门直肠畸形患儿直肠末端的表达及意义[J].中华小儿外科杂志,2014,35(7):553-556.
[6]林飞飞,干芸根,刘磊,等.先天性肛门直肠畸形术前盆底横纹肌CT诊断价值[J].中国临床医学影像杂志,2010,21(4):298-299.
[7]郭晓东,陈俊杰,胡东来,等.MRI盆底肌三维重建引导一期根治新生儿中高位肛门闭锁[J]中华小儿外科,2014,35(11):844-847.
[8]郑珊,张培,董岿然,等.先天性肛门直肠畸形肛门成形术后再手术的临床分析[J].中华小儿外科杂志,2012,33(4):296-299.
[9]明安晓,李龙,刘树立,等.腹腔镜辅助治疗中高位肛门直肠畸形疗效评价[J].中华小儿外科杂志,2011,32(7):504-508.
[10]张瑾,解杨子,张生奋.神经在皮肤创伤再生和瘢痕愈合中的作用.中国理论康复与实践,2015,21(8):921-923.
[11]Smith ME,Totten A,Hickam DH,et al.Pressur eulcer treatment strategies:a systematic comparative effectiveness review[J].Ann Intern Med,2013,159(1):39-50.
[12]Barisic G,Krivokapic Z.Adynamic and dynamic muscle transposition techniques for anal incontinence[J].Gastroenterology Report,2014,2(2):98-105.
[13]崔正民,陈维秀,陈雨历,等.股薄肌转移代肛门外括约肌重建术治疗大便失禁[J]临床小儿外科科杂志,2005,4(6):414-416.
[14]Liu Y,Grumbles RM,Thomas CK.Electrical stimulation of transplanted motoneurons improves motor unit formation[J].J Neurophysiol,2014,112(3):660-670.
[15]Hayakawa T,Kuwahara-Otani S,Maeda S,et a1.Projec-tions of calcitonin gene-related pepfide immunoreactive neurons in the vagal ganglia of the rat[J].J Chem Neuroanat,2011,41(1):55-62.
[16]王若义,秦虹,徐加龙,等.改良股薄肌转移代外括约肌行肛门重建治疗肛门闭锁术后大便失禁[J].中华小儿外科杂志,2016,37(4):267-272.
[17]Mik M,ros niak K,narbutt P,et al.Anterior overlapping sphincteroplasty–who benefits from the surgery?[J]Pol Przegl chir,2014,86(1):33-38.