Cera Susan M, Wexner Steven D
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA.
Clin Colon Rectal Surg. 2005 Feb;18(1):46-54. doi: 10.1055/s-2005-864081.
Since the early 1900s, skeletal muscle transpositions have been employed for complicated cases of fecal incontinence to augment or replace the anal sphincter. Multiple techniques have evolved that vary with the type and configuration of muscle used in the reconstruction. Transposition of the gluteus maximus muscle was popular in the early stages of development but was replaced by techniques involving transposition of the gracilis muscle. Within the past 16 years, electrical stimulators have been applied to the transposed muscle flaps to create a dynamic reconstruction improving the efficacy of these neosphincters over their static counterparts. However, the stimulated versions are technically demanding with a high rate of morbidity secondary to complications of the multiple components and variations in technique. The stimulator used in this procedure has been removed from the US market, although it is still available in other countries. Currently in the United States, gracilis transposition is still employed in the absence of an electrical stimulator as an adjunct to the artificial bowel sphincter (Acticon Neosphincter, American Medical Systems, Minnetonka, MN), such as in cases of severe muscle loss and congenital atresia. In European countries, the stimulated graciloplasty continues to evolve, leading to expansion of its use in total anorectal reconstruction for anal atresia and after abdominoperineal resection.
自20世纪初以来，骨骼肌移位术已被用于治疗复杂的大便失禁病例，以增强或替代肛门括约肌。随着重建中使用的肌肉类型和结构的不同，已经发展出多种技术。臀大肌移位术在发展初期很流行，但后来被涉及股薄肌移位的技术所取代。在过去的16年里，电刺激器已被应用于移位的肌皮瓣，以进行动态重建，从而提高这些新括约肌相对于静态括约肌的疗效。然而，带刺激器的手术技术要求高，由于多个组件的并发症和技术差异，发病率很高。该手术中使用的刺激器已从美国市场撤下，尽管在其他国家仍可获得。目前在美国，在没有电刺激器的情况下，股薄肌移位术仍被用作人工肠括约肌（Acticon Neosphincter，美国医疗系统公司，明尼通卡，明尼苏达州）的辅助手段，例如在严重肌肉缺失和先天性闭锁的病例中。在欧洲国家，带刺激器的股薄肌成形术仍在不断发展，导致其在肛门闭锁和腹会阴切除术后的全肛管直肠重建中的应用不断扩大。
