Bourdelat D, Barbet J P, Gross P
Service de Chirurgie pédiatrique, Hôpital Delafontaine, Saint-Denis.
Chirurgie. 1994;120(1):48-52.
Anorectal sphincteromyectomy is a suitable answer to the problem of the chronic constipation in childhood. It took a long time to be recognized beside others methods as biofeedack. This surgical procedure has been described for the first time by B. Duhamel in 1965; we still remained faithful and proud of this idea. We wanted to understand and to explain the basis of the conception of anorectal achalasia. Several works about the fetal development of the anorectal sphincter tried to explain it. A good exposition makes the technique less difficult and the dissection of the internal sphincter easier. We have analysed our 22 recent children. In 21 cases, we noticed a good result. The histological study of the fragment of the myomectomy showed a normal cytology of the smooth muscular tissue, a normal intrinsic innervation and arterial vascularisation. The surgical procedure is efficient because it relieves the functional disorder of the internal anal sphincter. It is a mechanical action; the external sphincter finds again its normal function, or is allowed to be reeducated.
肛门直肠括约肌切除术是解决儿童慢性便秘问题的一个合适办法。与生物反馈等其他方法相比，它经过很长时间才得到认可。这种外科手术最早由B. 杜阿梅尔于1965年描述；我们至今仍秉持并为这一理念感到自豪。我们想理解并解释肛门直肠失弛缓症概念的基础。关于肛门直肠括约肌胎儿发育的几项研究试图对此进行解释。详细的阐述使该技术难度降低，内括约肌的解剖更容易。我们分析了近期的22例患儿。在21例中，我们观察到了良好的效果。肌瘤切除术标本的组织学研究显示平滑肌组织的细胞学正常、内在神经支配正常以及动脉血管化正常。该外科手术之所以有效，是因为它缓解了肛门内括约肌的功能障碍。这是一种机械作用；外括约肌恢复了其正常功能，或者能够接受再训练。
