Bardoel J W, Stadelmann W K, Perez-Abadia G A, Galandiuk S, Zonnevijlle E D, Maldonado C, Stremel R W, Tobin G R, Kon M, Barker J H
Department of Surgery, University of Louisville, KY 40292, USA.
Plast Reconstr Surg. 2001 Feb;107(2):478-84. doi: 10.1097/00006534-200102000-00025.
Fecal stomal incontinence is a problem that continues to defy surgical treatment. Previous attempts to create continent stomas using dynamic myoplasty have had limited success due to denervation atrophy of the muscle flap used in the creation of the sphincter and because of muscle fatigue resulting from continuous electrical stimulation. To address the problem of denervation atrophy, a stomal sphincter was designed using the most caudal segment of the rectus abdominis muscle, preserving its intercostal innervation as well as its vascular supply. The purpose of the present study was to determine whether this rectus abdominis muscle island flap sphincter design could maintain stomal continence acutely. In this experiment, six dogs were used to create eight rectus abdominis island flap stoma sphincters around a segment of distal ileum. Initially, the intraluminal stomal pressures generated by the sphincter using different stimulation frequencies were determined. The ability of this stomal sphincter to generate continence at different intraluminal bowel pressures was then assessed. In all cases, the rectus abdominis muscle sphincter generated peak pressures well above those needed to maintain stomal continence (60 mmHg). In addition, each sphincter was able to maintain stomal continence at all intraluminal bowel pressures tested.
粪便性造口失禁是一个仍难以通过手术治疗解决的问题。以往尝试通过动态肌成形术创建可控性造口，但由于在创建括约肌时使用的肌瓣去神经萎缩，以及持续电刺激导致的肌肉疲劳，成效有限。为解决去神经萎缩问题，利用腹直肌最尾端部分设计了一种造口括约肌，保留其肋间神经支配和血管供应。本研究的目的是确定这种腹直肌岛状皮瓣括约肌设计能否在急性期维持造口的节制功能。在该实验中，使用6只犬在一段回肠远端周围创建了8个腹直肌岛状皮瓣造口括约肌。最初，测定了括约肌在不同刺激频率下产生的腔内造口压力。然后评估了这种造口括约肌在不同腔内肠压下产生节制功能的能力。在所有情况下，腹直肌肌括约肌产生的峰值压力远高于维持造口节制所需的压力（60 mmHg）。此外，每个括约肌在所有测试的腔内肠压下均能维持造口节制。
