Romano Giovanni, La Torre Filippo, Cutini Giorgio, Bianco Francesco, Esposito Pasquale, Montori Alberto
Department of Emergency Surgery, S. Giuseppe Moscati Hospital, Avellino, Italy.
Dis Colon Rectum. 2003 Jun;46(6):730-4. doi: 10.1007/s10350-004-6649-3.
The artificial bowel sphincter has been proposed to treat patients with fecal incontinence. The good results achieved with this procedure encouraged us to use this device for reconversion of patients who previously underwent an abdominoperineal resection.
Between 1999 and 2001, we selected eight patients for the total anorectal reconstruction, five for a synchronous reconstruction, and three cases for a delayed procedure. One patient was male and seven were female. The mean age was 52.6 years. All the patients underwent a postoperative manometry and defecography. Continence and quality of life scores were also evaluated in the follow-up.
The follow-up length ranged from 6 to 28 months. Manometry assessed a basal pressure with the ABS cuff inflated between 58 and 62.2 mmHg. All but one patient achieved a good grade of continence with a Wexner score range between 3 and 9. A certain degree of impaired evacuation occurred in three patients, but with adequate training this improved and did not affect patient's satisfaction. The administered questionnaires demonstrated a significant improvement in quality of life scores for stoma patients and an elevated quality of life in patients synchronously treated with artificial bowel sphincter implant.
The artificial bowel sphincter is a good option for reconstruction of patients previously treated with an abdominoperineal resection. The procedure is feasible and safe, without serious postoperative complications. The quality of life is improved when the procedure is performed in stabilized stoma patients and is acceptable for motivated patients synchronously implanted. As compared with electrostimulated graciloplasty, the artificial bowel sphincter technique seems to be easier to perform and more acceptable for the patients, although the cost of the device is still high.
人工肛门括约肌已被用于治疗大便失禁患者。该手术取得的良好效果促使我们将此装置用于先前接受过腹会阴切除术患者的肛门重建。
1999年至2001年间，我们选择了8例患者进行全肛管直肠重建，其中5例为同期重建，3例为延期手术。1例男性，7例女性。平均年龄52.6岁。所有患者术后均接受了测压和排粪造影检查。随访期间还评估了控便能力和生活质量评分。
随访时间为6至28个月。测压显示，人工肛门括约肌袖带充气时的基础压力在58至62.2 mmHg之间。除1例患者外，所有患者的控便能力良好，Wexner评分为3至9分。3例患者出现一定程度的排便障碍，但经过适当训练后有所改善，且未影响患者满意度。所发放的问卷显示，造口患者的生活质量评分有显著改善，同期植入人工肛门括约肌的患者生活质量有所提高。
人工肛门括约肌是先前接受过腹会阴切除术患者重建的良好选择。该手术可行且安全，无严重术后并发症。对于病情稳定的造口患者，该手术可改善生活质量，对于有意愿同期植入的患者也是可以接受的。与电刺激股薄肌成形术相比，人工肛门括约肌技术似乎更容易实施，患者也更容易接受，尽管该装置的成本仍然很高。
