低位型肛门直肠畸形中出现的意外变形的肛门括约肌。
Unexpectedly deformed anal sphincter in low-type anorectal malformation.
机构信息
Aichi Children's Health and Medical Center, Obu-city, Aichi 474-8710, Japan.
出版信息
J Pediatr Surg. 2009 Dec;44(12):2375-9. doi: 10.1016/j.jpedsurg.2009.07.073.
PURPOSE
The sphincter muscles in anorectal anomalies, which do not appear in the surgical field, cannot be described adequately. Details of the anal sphincter in low-type anorectal malformations were investigated using 3-dimensional (3D) image analysis.
PATIENTS AND METHODS
Thirty patients (10 males and 20 females) with low-type anorectal malformation were investigated with multidetector-row helical computed tomography. An image of the anorectal part was obtained with a slice thickness of 1 mm and a reconstruction pitch of 0.5 mm. A 3D reconstruction on a personal computer was made with a volume rendering method assisted by our own software (NewVES).
RESULTS
Very thin vertical fibers (VFs) were observed behind the fistula in almost half of the low-type cases. They did not wrap the distal end of the fistula. The 3D images of these sphincters were different in each case.
DISCUSSION
The fistula was dislocated forward from the deformed hypoplastic sphincter. We suggest that surgical mobilization of the anorectum into the center of the hypoplastic sphincter would be difficult using the cut back or Potts methods.
CONCLUSION
The choice of surgical method should take into consideration the displaced and deformed hypoplastic anal sphincter.
目的
肛门直肠畸形中不存在于手术视野内的括约肌肉无法充分描述。本研究采用三维（3D）图像分析来研究低位型肛门直肠畸形中肛门括约肌的详细情况。
方法
对 30 例低位型肛门直肠畸形患者（男 10 例，女 20 例）进行多排螺旋 CT 检查。层厚 1mm，重建间隔 0.5mm，获得肛门直肠部分的图像。使用个人电脑，通过我们自己的软件（NewVES）辅助容积再现方法进行 3D 重建。
结果
几乎一半的低位型病例在瘘管后面观察到非常细的垂直纤维（VFs），它们没有包裹瘘管的远端。这些括约肌的 3D 图像在每个病例中都不同。
讨论
瘘管从发育不良的萎缩性括约肌向前移位。我们认为，使用后切或 Potts 方法将肛门直肠向发育不良的括约肌中心移动可能会很困难。
结论
手术方法的选择应考虑移位和变形的发育不良的肛门括约肌。
Zotero 插件