Richard C, Bernard D, Morgan S, Tassé D, Wassef R
Département de Chirurgie, Hôpital Saint-Luc, Montréal, Québec, Canada.
Ann Chir. 1994;48(8):703-7.
Surgical repair of the anal sphincters after previous trauma is generally successful. In earlier publications, a protective colostomy was recommended but in most recent series colostomy is omitted. We have been through both phases and this is the first comparative study done on 82 consecutive repairs: 45 with colostomy from 1977 to 1986 (Group I) and 37 without colostomy from 1986 to 1992 (Group II). Causes of trauma were obstetrical: 50, surgical: 24 and violence: 5. Apart from colostomy related morbidity, postoperative complication rates were similar in the two groups. Results were graded excellent, good, fair or poor according to continence to solids, to liquids and soiling. Good and excellent results were obtained in 82% (Group I) and 87% (Group II) after a mean follow-up duration of 42 and 23 months respectively. Furthermore there was no difference between Group I and II in the rate of good/excellent results for cases who had undergone prior repairs (98% v. 100%) and also when the duration of incontinence was more than 10 years (71% v. 83%). We conclude that colostomy is not a determinant factor in the outcome and is therefore not required, avoiding all colostomy related morbidity and disability.
既往创伤后肛门括约肌的手术修复通常是成功的。在早期的文献中，建议行保护性结肠造口术，但在最近的系列研究中，结肠造口术已被省略。我们经历了这两个阶段，这是对82例连续修复病例进行的首次比较研究：1977年至1986年有45例行结肠造口术（第一组），1986年至1992年有37例未行结肠造口术（第二组）。创伤原因包括产科因素：50例，手术因素：24例，暴力因素：5例。除了与结肠造口术相关的发病率外，两组的术后并发症发生率相似。根据对固体、液体的控便能力及有无弄脏情况将结果分为优、良、中或差。第一组和第二组分别在平均随访42个月和23个月后，优和良的结果分别为82%和87%。此外，对于既往已行修复手术的病例（98%对100%）以及失禁持续时间超过10年的病例（71%对83%），第一组和第二组在优/良结果率方面没有差异。我们得出结论，结肠造口术不是结果的决定性因素，因此不需要行结肠造口术，可避免所有与结肠造口术相关的发病率和残疾情况。
