Colorectal Research Group, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
Dis Colon Rectum. 2009 Oct;52(10):1681-7. doi: 10.1007/DCR.0b013e3181b13862.
Anterior sphincteroplasty is the surgical treatment of choice for patients with fecal incontinence associated with an external anal sphincter defect. Recently it has been reported that patients with such a defect may also benefit from sacral neuromodulation. The success of this technique raises the question whether anterior sphincteroplasty still deserves a place in the surgical treatment of fecal incontinence. This study investigated the outcome of anterior sphincteroplasty in a large cohort of patients.
A consecutive series of 172 patients underwent anterior overlapping sphincteroplasty. A standardized questionnaire concerning current continence status, overall satisfaction, and quality of life was used to assess the outcome.
Follow-up data were obtained from 75% of the 160 patients who were still alive at the time of the survey. After a median follow-up of 111 (range, 12-207) months, the outcome was still good to excellent in 44 patients (37%). In 28 patients (23%), the outcome was classified as moderate because these patients still experienced regular incontinence for stool. However, they were satisfied with their outcome because their incontinence episodes had been reduced by 50% or more. The outcome was poor in 40% of the patients. Predictors of worse outcome were older age (> or =50 years) at surgery, deep wound infection, and isolated external anal sphincter defects. Patients with follow-up of five or more years had the same outcome as patients with follow-up of fewer than five years.
Anterior sphincteroplasty results in an acceptable to excellent long-term outcome in 60% of patients, especially in those under the age of 50 years at surgery.
肛门外括约肌缺陷所致大便失禁的首选治疗方法是肛门成形术。最近有报道称，此类缺陷患者还可能受益于骶神经调节。该技术的成功提出了一个问题，即肛门成形术在大便失禁的外科治疗中是否仍有一席之地。本研究调查了大量患者中肛门成形术的结果。
连续 172 例患者接受了前重叠括约肌成形术。使用标准化问卷评估当前的控便状态、总体满意度和生活质量，以评估结果。
在调查时仍存活的 160 例患者中有 75%获得了随访数据。中位随访时间为 111 个月（范围 12-207 个月）后，44 例（37%）患者的结果仍良好至优秀。28 例（23%）患者的结果被归类为中度，因为这些患者仍有规律的粪便失禁，但他们对自己的结果感到满意，因为他们的失禁次数减少了 50%或更多。40%的患者结果较差。较差结果的预测因素为手术时年龄较大（≥50 岁）、深部伤口感染和孤立的肛门外括约肌缺陷。随访 5 年以上和随访 5 年以下的患者的结果相同。
肛门成形术在 60%的患者中可获得可接受至良好的长期结果，尤其是在手术时年龄小于 50 岁的患者。
