Lunniss P J, Kamm M A, Phillips R K
Department of Surgery, St. Bartholomew's Hospital, London, UK.
Br J Surg. 1994 Sep;81(9):1382-5. doi: 10.1002/bjs.1800810947.
Anorectal physiology and continence were assessed prospectively before and after surgery in 50 patients with chronic perianal sepsis. Functional and physiological parameters were unchanged after surgery in 13 control patients who had sepsis but who did not undergo division of the anal sphincter. Group 1 comprised 22 patients with internal sphincter division alone (15 intersphincteric, seven trans-sphincteric treated by a loose seton technique) and group 2 consisted of 15 patients with a trans-sphincteric fistula laid completely open. In group 1 the median (interquartile range (i.q.r.)) resting pressure in the distal 1 cm of the anal canal was reduced from 68 (60-90) cmH2O before surgery to 44 (35-60) cmH2O after operation (P < 0.001); squeeze pressure was less affected, but function deteriorated in 11 of the 22 patients. The median (i.q.r.) resting pressure in group 2 patients also fell, from 68 (34-84) cmH2O before operation to 28 (20-54) cmH2O afterwards (P = 0.003); median (i.q.r.) maximum squeeze pressure decreased more, from 124 (76-170) cmH2O to 72 (48-112) cmH2O (P = 0.002). Functional deficit occurred in eight of the 15 patients. Incontinence was related to low resting pressure, reflecting internal sphincter integrity, and to local epithelial electrosensitivity (reflecting scarring), but not to squeeze pressure, fistula type or surgical treatment.
对50例慢性肛周脓毒症患者在手术前后进行了前瞻性的肛门直肠生理学和控便能力评估。13例患有脓毒症但未接受肛门括约肌切开术的对照患者术后功能和生理参数未发生变化。第1组包括22例仅行内括约肌切开术的患者（15例为括约肌间切开术，7例为经括约肌切开术，采用宽松挂线技术治疗），第2组由15例完全敞开的经括约肌肛瘘患者组成。在第1组中，肛管远端1 cm处的静息压力中位数（四分位间距（i.q.r.））从术前的68（60 - 90）cmH₂O降至术后的44（35 - 60）cmH₂O（P < 0.001）；挤压压力受影响较小，但22例患者中有11例功能恶化。第2组患者的静息压力中位数（i.q.r.）也下降，从术前的68（34 - 84）cmH₂O降至术后的28（20 - 54）cmH₂O（P = 0.003）；最大挤压压力中位数（i.q.r.）下降更多，从124（76 - 170）cmH₂O降至72（48 - 112）cmH₂O（P = 0.002）。15例患者中有8例出现功能缺陷。大便失禁与反映内括约肌完整性的低静息压力以及局部上皮电敏感性（反映瘢痕形成）有关，但与挤压压力、肛瘘类型或手术治疗无关。
