Department of Surgery, Faculty of Medicine, International Islamic University, Kuantan, Malaysia.
World J Surg. 2010 Jul;34(7):1641-7. doi: 10.1007/s00268-010-0489-1.
We undertook a prospective longitudinal study of patients with end-stage fecal incontinence who were undergoing transposition of the gracilis muscle as a neo-anal sphincter with external low-frequency electrical stimulation of the nerve to the gracilis combined with biofeedback.
A total of 31 patients (21 male, 10 female: median age: 22 years; range: 4-77 years) underwent this procedure for treatment of traumatic disruption (11 patients, 35%), congenital atresia (11 patients, 35%), iatrogenic injury (6-20%), and perineal sepsis (3 patients, 10%). The gracilis muscle was transposed at operation in an alpha or gamma configuration. Low-frequency (7 Hz) transcutaneous electrical stimulation commenced 2 weeks after operation and was continued for up to 12 weeks. Biofeedback therapy, which consisted of supervised neosphincter squeeze exercises, commenced simultaneously and continued for up to 28 weeks. Outcome was assessed by clinical examination, anal manometry, the Cleveland Clinic Florida continence score (CCFS), and the Rockwood quality of life scale (FIQL). Successful outcome was defined by improvement in clinical outcome, patient satisfaction, a positive result on anal manometry, and/or CCFS < 9, or FIQL > or = 4.
At median follow-up of 67 months, overall improvement was seen in 22 (71%). Maximum resting pressure (MRP) and maximum squeeze pressure (MSP) improved significantly after operation [MRP pre versus post, mean (SD), cm water-13.8 (9.6) versus 20.9 (11.3); P = 0.01; and MSP 36.6 (22.4) versus 95.4 (71.2), P = 0.001]. In a subset of 18 patients who showed improvement after operation, the CCFS score (mean, SD) improved from 19.2 (3.4) to 5.2 (5.6); P = 0.0001. FIQL (mean, SD) showed significant improvement in all four domains in 14 patients who reported improvement since the year 2000.
A modified dynamic gracilis neoanal sphincter for end-stage fecal incontinence helps restore and sustain continence with improvement in quality of life in the majority of patients. The procedure was most effective as augmentation in those who had suffered a traumatic injury, when compared with patients with congenital atresia and sepsis that had resulted in loss of the native anal sphincter.
我们进行了一项前瞻性纵向研究，纳入了 31 例终末期粪便失禁患者，这些患者接受了腹直肌转位术作为新的肛门括约肌，同时联合使用外部低频电刺激腹直肌神经和生物反馈。
共有 31 例患者（21 例男性，10 例女性；中位年龄：22 岁；范围：4-77 岁）接受了该手术治疗，病因包括创伤性撕裂（11 例，35%）、先天性闭锁（11 例，35%）、医源性损伤（6-20%）和会阴脓肿（3 例，10%）。手术中以α或γ构型进行腹直肌转位。低频（7 Hz）经皮电刺激在术后 2 周开始，并持续 12 周。生物反馈治疗包括监督新括约肌收缩练习，同时开始，并持续 28 周。通过临床检查、肛门测压、佛罗里达克利夫兰诊所失禁评分（CCFS）和 Rockwood 生活质量评分（FIQL）评估结果。成功的定义是临床结果改善、患者满意度、肛门测压阳性结果和/或 CCFS＜9 分，或 FIQL≥4 分。
中位随访 67 个月时，22 例（71%）患者整体情况改善。术后最大静息压（MRP）和最大收缩压（MSP）显著改善[术前 MRP，平均（标准差），cm 水柱 13.8（9.6）与 20.9（11.3）；P=0.01；和 MSP 36.6（22.4）与 95.4（71.2），P=0.001]。在术后表现出改善的 18 例患者中，CCFS 评分（平均值，标准差）从 19.2（3.4）改善至 5.2（5.6）；P=0.0001。自 2000 年以来，14 例报告生活质量改善的患者的 FIQL（平均值，标准差）在所有四个领域均有显著改善。
改良的动态腹直肌新肛门括约肌治疗终末期粪便失禁，有助于恢复和维持大部分患者的控便能力，并改善生活质量。在因创伤而导致的患者中，该手术比因先天性闭锁和感染导致的固有肛门括约肌丧失的患者更为有效。
