Jacobs P P, Scheuer M, Kuijpers J H, Vingerhoets M H
Department of General Surgery, University Hospital Nijmegen, The Netherlands.
Dis Colon Rectum. 1990 Jun;33(6):494-7. doi: 10.1007/BF02052145.
During the last five years, 37 patients with fecal incontinence because of childbirth have been investigated. Ages varied from 22 to 62 years and duration of symptoms from 0.3 to 26 years. Anal manometry was performed in all patients and electromyography was performed in 24 patients. Thirty patients underwent delayed sphincter repair. In all patients, a dehiscence was found anteriorly, bridged by scar tissue. Continence was restored in 25 patients (83 percent). Electromyography was performed postoperatively in patients who remained incontinent and who demonstrated severe denervation. All these patients had undergone previous sphincter repair. In seven patients, there were no signs of obstetric injury. Electromyography demonstrated severe denervation, but sphincter mapping did not demonstrate muscle discontinuity. Continence improved in four patients within one year as a result of reinnervation demonstrated by electromyography. The authors conclude that fecal incontinence after childbirth may be due to either obstetric rupture or denervation. Both disorders may coexist. Delayed sphincter repair gives excellent results provided that denervation is not present. Preoperative assessment with electromyography is mandatory.
在过去五年中，对37例因分娩导致大便失禁的患者进行了调查。患者年龄在22岁至62岁之间，症状持续时间为0.3年至26年。所有患者均进行了肛门测压，24例患者进行了肌电图检查。30例患者接受了延迟括约肌修复术。在所有患者中，均发现前方有裂开，由瘢痕组织桥接。25例患者（83%）恢复了控便能力。对仍有失禁且表现出严重去神经支配的患者术后进行了肌电图检查。所有这些患者此前均接受过括约肌修复术。7例患者没有产科损伤的迹象。肌电图显示严重去神经支配，但括约肌定位未显示肌肉连续性。由于肌电图显示神经再支配，4例患者在一年内控便能力有所改善。作者得出结论，产后大便失禁可能是由于产科撕裂或去神经支配所致。这两种病症可能同时存在。如果不存在去神经支配，延迟括约肌修复术会取得极佳效果。术前必须进行肌电图评估。
