Chase Suchita, Mittal Rohin, Jesudason Mark Ranjan, Nayak Sukria, Perakath Benjamin
Department of Surgery Unit 5 (Colorectal Surgery), Christian Medical College and Hospital, Vellore, Tamil Nadu 632004, India.
Indian J Gastroenterol. 2010 Jul;29(4):162-5. doi: 10.1007/s12664-010-0037-9. Epub 2010 Aug 7.
Structural anal sphincter damage may be secondary to obstetric anal sphincter injury, perineal trauma or anorectal surgery. We reviewed the spectrum of anal sphincter injuries and their outcomes in a tertiary care colorectal unit.
Data of patients who underwent anal sphincter repair between 2004 and 2008 were analyzed retrospectively. Outcomes were compared with respect to etiology, type of repair, previous attempts at repair and manometry findings. Outcomes were defined as good or poor based on patient satisfaction as the primary criteria.
Thirty-four patients underwent anal sphincter repair. Twenty-two injuries were obstetric, eight traumatic, and four iatrogenic. All patients underwent overlap sphincteroplasty with six additional anterior levatorplasty and seven graciloplasty. Twenty-three (67.6%) patients had a good outcome while nine (26.4%) had a poor outcome. All patients who had augmentation anterior levatorplasty had a good outcome. Fifty percent of patients with a previous sphincter repair and 42.9% requiring augmentation graciloplasty had a poor outcome. Median resting and squeeze anal pressures increased from 57.5 to 70 cmH₂O and 90.25 to 111 cmH₂O in those with a good outcome.
Overlap sphincteroplasty has a good outcome in majority of the patients with incontinence due to a structural sphincter defect. Additional anterior levatorplasty may improve outcomes. Previous failed repairs or use of a gracilis muscle augmentation may have a worse outcome secondary to poor native sphincter muscle. Improvement in resting and squeeze pressures on anal manometry may be associated with a good outcome.
结构性肛门括约肌损伤可能继发于产科肛门括约肌损伤、会阴创伤或肛肠手术。我们回顾了在一家三级医疗结直肠科单位中肛门括约肌损伤的范围及其治疗结果。
对2004年至2008年间接受肛门括约肌修复术的患者数据进行回顾性分析。根据病因、修复类型、既往修复尝试和测压结果对治疗结果进行比较。以患者满意度作为主要标准，将治疗结果定义为良好或不佳。
34例患者接受了肛门括约肌修复术。其中22例损伤为产科原因，8例为创伤性，4例为医源性。所有患者均接受了重叠式括约肌成形术，另外6例接受了前路提肛肌成形术，7例接受了股薄肌成形术。23例（67.6%）患者治疗结果良好，9例（26.4%）患者治疗结果不佳。所有接受前路提肛肌成形术增强的患者治疗结果均良好。既往接受过括约肌修复术的患者中有50%以及需要股薄肌成形术增强的患者中有42.9%治疗结果不佳。治疗结果良好的患者静息和收缩时的肛门压力中位数分别从57.5 cmH₂O升至70 cmH₂O，从90.25 cmH₂O升至111 cmH₂O。
对于大多数因结构性括约肌缺陷导致尿失禁的患者，重叠式括约肌成形术治疗效果良好。额外的前路提肛肌成形术可能会改善治疗结果。既往修复失败或使用股薄肌增强术可能因天然括约肌肌肉状况不佳而导致更差的治疗结果。肛门测压中静息和收缩压力的改善可能与良好的治疗结果相关。
