• 四川大學(xué)華西醫(yī)院（成都，610041） 1 小兒外科，2 超聲診斷科;

目的 探討臀大肌代肛門括約肌控便手術(shù)治療高位無肛術(shù)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(huì)陰聯(lián)合肛門成形術(shù)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(shù)
治療。男11 例，女14 例；年齡3 ～ 22 歲，平均10.2 歲。術(shù)前直腸造影、肛管直腸測(cè)壓及肌電圖檢查顯示肛門括約肌功能
缺失或嚴(yán)重不良。采用Wexner 評(píng)分、大便失禁生活質(zhì)量調(diào)查問卷（FIQL）、自測(cè)健康評(píng)定量表（SRHMS）評(píng)定患者生活質(zhì)
量，并行肛管直腸測(cè)壓、肛管直腸腔內(nèi)超聲檢查、動(dòng)態(tài)排便造影檢查。 結(jié)果 術(shù)后1 周2 例患者發(fā)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(shí)間1 ～ 9 年，平均6.3 年。大便次數(shù)由術(shù)前每天10 余次減少至4 ～ 6 次。術(shù)
后1 年及術(shù)后2 年及以上Wexner 評(píng)分及SRHMS 自測(cè)評(píng)分與術(shù)前比較，差異均有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）；術(shù)后2 年及以
上FIQL 評(píng)分較術(shù)前及術(shù)后1 年明顯改善（P  lt; 0.05）。肛管直腸測(cè)壓結(jié)果示術(shù)后2 年及以上患者肛管最大收縮壓、收縮持
續(xù)時(shí)間及最大收縮容積較術(shù)前及術(shù)后1 年明顯提高，差異有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）。 結(jié)論 臀大肌代肛門括約肌手術(shù)
能一定程度改善高位無肛術(shù)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(shù)后大便失禁. 中國修復(fù)重建外科雜志, 2012, 26(5): 571-575. doi: 復(fù)制

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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(huì), 胡敏燕, 等. 自測(cè)健康評(píng)定量表的研制與考評(píng). 中國行為醫(yī)學(xué)科學(xué), 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(shù)后遠(yuǎn)期生活質(zhì)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(zhuǎn)位重建肛門外括約肌的應(yīng)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(shù)后排便功能評(píng)估標(biāo)準(zhǔn). 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. 1. Peña A. Surgical management of anorectal malformations: a unified concept. Pediatr Surg Int, 1988, 3(2-3): 82-93.
  2. 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. 3. Aliev EA. Surgical treatment of anal sphincter insufficiency using the flaps of the gluteus maximus muscle. Klin Khir, 2010, (6): 46-49.
  4. 4. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1): 77-97.
  5. 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. 6. 許軍, 王斌會(huì), 胡敏燕, 等. 自測(cè)健康評(píng)定量表的研制與考評(píng). 中國行為醫(yī)學(xué)科學(xué), 2000, 9(1): 65-68.
  7. 7. Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology, 2006, 130(5): 1527-1537.
  8. 8. 白玉作, 王維林, 王慧貞, 等. 小兒肛門直腸畸形術(shù)后遠(yuǎn)期生活質(zhì)量的初步研究. 中華小兒外科雜志, 1999, 20(5): 263-266.
  9. 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. 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. 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. 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. 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. 14. 陳姬, 李福玉, 劉利君, 等. 兒童臀大肌下部肌瓣轉(zhuǎn)位重建肛門外括約肌的應(yīng)用解剖. 解剖與臨床, 2007, 12(4): 243-245, 249.
  15. 15. Cera SM, Wexner SD. Muscle transposition: does it still have a role? Clin Colon Rectal Surg, 2005, 18(1): 46-54.
  16. 16. 張震, 吳曄明. 先天性肛門直腸畸形術(shù)后排便功能評(píng)估標(biāo)準(zhǔn). 臨床小兒外科雜志, 2008, 7(4): 52-54, 63.
  17. 17. Hancock BD, Smith K. The internal sphincter and Lord’s procedure for haemorrhoids. Br J Surg, 1975, 62(10): 833-836.