Holschneider A M, Amano S, Löhrs U, Donhauser G, Biese K, Kämpf B
Z Kinderchir. 1984 Jun;39(3):191-201. doi: 10.1055/s-2008-1044207.
Anorectal smooth muscles pedicle flaps (funnel grafts) according to the dragging method described by Holschneider in 1980, 1981 and Hofmann-von Kap-herr and Koltai 1981 were performed on 20 Syrian goats and German pedigree goats. Postoperatively, three animals died because of pulmonary infection with worms; 17 animals could be examined. Six of these 17 animals died during the postoperative follow-up period from the sequels of the operation. In five animals the cause of death was prestretching of the transplant by 150 and 200%; three of these developed severe enterocolitis, whereas two had stenosis and ileus, resulting in death in each case. In addition, five further animals showed signs of enterocolitis; eight goats had constipation which in every case could be ascribed to prestretching of the transplant by 150% and more. These animals had to be treated by infusion and bouginage, leading to recession of the signs after four to six days. Electromanometrically an increased anorectal resting pressure profile was found postoperatively in all cases, i.e. even if the transplant was prestretched to tension values of only over 100%. Relaxations of the internal anal sphincter could be achieved in all animals; however, in goats with a transplant stretch of 150% and more they were observed only after the resting pressure profile had receded, a few months after the operation. Histologically, there was increasing fibrosis and disintegration of the transplant in all animals with more than 150% prestretch. With 200% prestretch, the plexus myentericus disintegrated also, so that no relaxation could be achieved. Basing on these clinical, manometrical and histological results, smooth muscle transposition (funnel graft) can be recommended to improve continence in infants by employing the dragging method according to Rehbein-Romualdi. However, prestretching of the transplanted pedicle flap should not exceed 120-140%.
按照霍尔施奈德于1980年、1981年以及霍夫曼 - 冯·卡佩尔和科尔泰于1981年所描述的拖拽方法，对20只叙利亚山羊和德国纯种山羊实施了肛门直肠平滑肌蒂瓣（漏斗移植）手术。术后，3只动物因肺部蠕虫感染死亡；17只动物可供检查。这17只动物中有6只在术后随访期间因手术后遗症死亡。在5只动物中，死亡原因是移植组织被预拉伸150%和200%；其中3只出现严重小肠结肠炎，另外2只出现狭窄和肠梗阻，最终均死亡。此外，另有5只动物表现出小肠结肠炎症状；8只山羊出现便秘，在每种情况下，便秘都可归因于移植组织被预拉伸150%及以上。这些动物必须通过输液和探条扩张进行治疗，4至6天后症状缓解。通过压力测定法发现，术后所有病例的肛门直肠静息压力曲线均升高，也就是说，即使移植组织仅被预拉伸至超过100%的张力值。所有动物的肛门内括约肌均可实现松弛；然而，在移植组织拉伸150%及以上的山羊中，仅在术后几个月静息压力曲线下降后才观察到松弛。组织学检查显示，在所有预拉伸超过150%的动物中，移植组织的纤维化和崩解程度都在增加。当预拉伸至200%时，肌间神经丛也会崩解，从而无法实现松弛。基于这些临床、压力测定和组织学结果，采用雷布因 - 罗穆阿尔迪的拖拽方法进行平滑肌移位（漏斗移植），可推荐用于改善婴儿的控便能力。然而，移植蒂瓣的预拉伸不应超过120% - 140%。
