Satava R M, King G E
Department of General Surgery, Eisenhower Army Medical Center, Fort Gordon, Georgia 30905.
J Surg Res. 1989 Mar;46(3):207-11. doi: 10.1016/0022-4804(89)90057-7.
To find an alternative to the stigmata of abdominal colostomy, an artificial anal sphincter (utilizing the currently available artificial urinary sphincter) was implanted around an end perineal colostomy following standard abdominal perineal resection. Of 13 swine, 7 completed full evaluation with working sphincters, 3 animals died prematurely of unrelated causes, and 3 animals were sacrificed due to sphincter slough before inflation was begun. Seven animals had long-term evaluation of the sphincter for 2 to 6 months' duration. In 5 animals (72%) there was complete fecal continence; one animal (14%) had occasional partial incontinence and one had total incontinence, both due to sphincter malfunction from breakage of the connecting tab. Two of the seven animals had delayed slough of the sphincter after 2 months and 4.5 months of success, and 2 animals had erosion of the intraperitoneal balloon reservoir into the small bowel. In addition, 5 of 9 (55%) control pumps were complicated by skin erosion or infection; all were relocated successfully. The fact that an intact artificial anal sphincter can provide excellent continence demonstrates that this concept of perineal placement for bowel control is valid. Refinements in the device to prevent tab breakage, investigation of correct sphincter pressures to prevent sloughing, and better sites for implantation of the pump and balloon reservoir are requisite solutions for a fully implantable system to restore near-normal bowel function after radical abdominal perineal resection.
为寻找腹部结肠造口术耻辱标志的替代方法，在标准腹会阴切除术后，将人工肛门括约肌（利用现有的人造尿道括约肌）植入会阴端结肠造口周围。13头猪中，7头完成了对有功能括约肌的全面评估，3头动物因无关原因过早死亡，3头动物在开始充气前因括约肌脱落而被处死。7头动物对括约肌进行了为期2至6个月的长期评估。5头动物（72%）实现了完全控便；1头动物（14%）偶尔出现部分失禁，1头动物完全失禁，两者均因连接片断裂导致括约肌功能故障。7头动物中有2头在成功使用2个月和4.5个月后出现括约肌延迟脱落，2头动物的腹腔内球囊贮器侵蚀进入小肠。此外，9个对照泵中有5个（55%）出现皮肤侵蚀或感染并发症；所有均成功重新安置。完整的人工肛门括约肌能够实现出色的控便，这一事实表明这种用于肠道控制的会阴放置概念是有效的。改进装置以防止连接片断裂、研究正确的括约肌压力以防止脱落，以及为泵和球囊贮器寻找更好的植入部位，是实现完全可植入系统以在根治性腹会阴切除术后恢复接近正常肠道功能的必要解决方案。
