Sonnino R E, Reinberg O, Bensoussan A L, Laberge J M, Blanchard H
Department of Pediatric Surgery, Montreal Children's Hospital, Quebec, Canada.
J Pediatr Surg. 1991 Oct;26(10):1219-23. doi: 10.1016/0022-3468(91)90338-t.
We report a series of 7 patients, aged 6.5 to 19 years (mean, 12.9), who have been treated for uncontrollable fecal incontinence since 1976: 5 had imperforate anus and multiple subsequent operative procedures, 1 had a low myelomeningocele with bi-sphincteric incontinence, and 1 had a traumatic destruction of the sphincter apparatus. A modified Pickrell procedure was performed, with the gracilis muscle transposed subcutaneously, without constructing a pulley through the median raphe as originally described. All patients were evaluated by anorectal manometry preoperatively and post-operatively. They were followed-up for a period of 0.5 to 12.5 years (mean, 4.4). All patients were continent at follow-up, with a normal defecation pattern and no enemas required. None of the patients had evidence of fibrosis of the muscle or anal canal, and tension in the transposed muscle was maintained. Voluntary contractions remain efficient in all cases. Age was thought to be an important factor: personal motivation and compliance with physiotherapy, essential for a good outcome, is unlikely to be present in the younger child. We conclude that the gracilis sling procedure is an excellent long-term alternative for total fecal incontinence when time and other therapeutic measures have failed.
我们报告了自1976年以来接受治疗的7例粪失禁无法控制的患者，年龄在6.5岁至19岁之间（平均12.9岁）：5例为肛门闭锁并多次后续手术，1例为低位脊髓脊膜膨出伴双括约肌失禁，1例为括约肌装置创伤性破坏。采用改良的皮克雷尔手术，将股薄肌皮下移位，未按最初描述的那样通过正中缝构建滑轮。所有患者术前和术后均接受了肛门直肠测压评估。随访时间为0.5年至12.5年（平均4.4年）。所有患者在随访时均能自主控制排便，排便模式正常，无需灌肠。所有患者均无肌肉或肛管纤维化的证据，移位肌肉的张力得以维持。所有病例中自主收缩仍然有效。年龄被认为是一个重要因素：个人动机和对物理治疗的依从性对良好预后至关重要，而年幼儿童不太可能具备这些。我们得出结论，当时间和其他治疗措施均失败时，股薄肌吊带手术是治疗完全性粪失禁的一种出色的长期替代方法。
