摘要
目的 探讨髂腰肌盆底悬吊术结合Malone顺行灌肠治疗神经性大便失禁的临床应用价值。方法 选择由脊髓发育不良所致的神经性大便失禁 14例 (年龄 4～ 13岁 ) ,均行双侧髂腰肌悬吊盆底加强术和阑尾造口术 ,术后配合顺行灌肠治疗。结果 14例获得随访 6～ 16个月 (平均 10 .4个月 ) ,术前术后临床主客观评分有显著性差异 ,术前术后直肠静息压无明显变化 ;直肠感觉阈、肛管直肠压差、肛管高压区长度和主动收缩压均有明显变化 ,2例因造瘘口狭窄未能坚持顺行灌肠。结论 髂腰肌盆底悬吊术结合Malone顺行灌肠是治疗神经性大便失禁的有效方法 ,可明显改善患儿的生活质量。
Objective To assess the result of pelvic floor suspension with iliopsoas in combination with Malone antegrade continence enema (MACE) as a treatment for neurogenic faecal incontinence. Methods Between October 1998 and December 1999, 14 patients (age: 4 to 13?years ) with neurogenic faecal incontinence secondary to myelodysplasia underwent suspension of pelvic floor with iliopsoas in combination with appendicostomy procedure. MACE was started 7 days post-operatively. Results Fourteen cases were followed-up for 6 to 16 months (mean , 10.4?months). All cases showed significant improvements. The clinical subjective and objective scores of the children were improved from 1.13± 0.74 and 1.67± 0.89 to 4.93± 0.96 and 3.93± 1.16 respectively. Anorectal manometry demonstrated that there was no significant difference in resting pressure of rectum; sensory threshold of rectum decreased from ( 55.73± 9.49)?ml to ( 32.54± 11.87)?ml; the difference between anus and rectum pressure , the length of high pressure zone and the contraction pressure were significantly improved from ( 12.41± 2.15)?cm,( 1.31± 1.11)?cm and ( 7.30± 2.31)?cm H 2O to ( 23.11± 3.56)?cm, (1.84±1.51)?cm H 2O and ( 30.52± 9.34)?cm H 2O respectively. Two patients could not initiate antegrade enema due to stomal stenosis. Conclusions Suspension of pelvic floor with iliopsoas in combination with MACE is effective in managing neurogenic faecal incontinence. The quality of life is improved significantly.
出处
《中华小儿外科杂志》
CSCD
北大核心
2001年第5期298-300,共3页
Chinese Journal of Pediatric Surgery
基金
卫生部临床学科重点资助项目 [49( 118) ]
