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[当前作为治疗大便失禁的前括约肌修复术的适应证、手术技术及结果]

[Current indications, surgical technique and results of anterior sphincter repair as a treatment of faecal incontinence].

作者信息

Dorcaratto Dimitri, Martínez-Vilalta Miquel, Parés David

机构信息

Unidad de Cirugía Colorrectal, Hospital Universitari del Mar, Barcelona, España.

出版信息

Cir Esp. 2010 May;87(5):273-81. doi: 10.1016/j.ciresp.2009.10.009. Epub 2010 Feb 6.

Abstract

Faecal incontinence is a high prevalence disease in the general population. This pathology is commonly under-estimated and causes a great impact on clinical status and on the quality of life of affected patients. The prevalence of faecal incontinence in several studies has been estimated between 2% and 15% of the general population. The prevalence increases if we study selected populations, such as elderly people. The main cause of faecal incontinence is obstetric anal sphincter damage. In the past years, the presence of incontinence due to sphincter lesions, especially the obstetric ones, was an absolute indication of anterior anal sphincter repair. Actually, after knowing the long term follow up results of this technique, as well as the evolving knowledge on faecal incontinence and the development of new diagnostic and therapeutic techniques, this technique might be selected for cases with large sphincter defects. However there is limited information in the current literature on indications, surgical technique and results of anterior sphincter repair. The aim of this review is to analyse scientific evidence on current indications, surgical technique features and results of anterior sphincter repair as a therapy for faecal incontinence, also giving our point of view on controversial issues. A bibliography search was undertaken using Medline database including articles published from January 1985 to January 2009.

摘要

大便失禁在普通人群中是一种高发性疾病。这种病症通常被低估,并且对患者的临床状况和生活质量产生重大影响。多项研究估计,普通人群中大便失禁的患病率在2%至15%之间。如果研究特定人群,如老年人,患病率会更高。大便失禁的主要原因是产科肛门括约肌损伤。在过去,因括约肌损伤导致的失禁,尤其是产科损伤导致的失禁,是进行肛门前括约肌修复的绝对指征。实际上,在了解了该技术的长期随访结果,以及对大便失禁的认识不断发展和新诊断与治疗技术出现之后,这种技术可能会被用于括约肌缺损较大的病例。然而,目前文献中关于肛门前括约肌修复的适应症、手术技术和结果的信息有限。本综述的目的是分析作为大便失禁治疗方法的肛门前括约肌修复的当前适应症、手术技术特点和结果的科学证据,并就有争议的问题发表我们的观点。我们使用Medline数据库进行了文献检索,检索范围包括1985年1月至2009年1月发表的文章。

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