Simmang C, Birnbaum E H, Kodner I J, Fry R D, Fleshman J W
Washington University School of Medicine, St. Louis, Missouri.
Dis Colon Rectum. 1994 Nov;37(11):1065-9. doi: 10.1007/BF02049804.
This study was designed to determine whether advancing age affects outcome after anal sphincter reconstruction.
Anal sphincter reconstruction, performed on patients 55 years of age and older, was reviewed to determine if functional outcome was adversely affected by advancing age. A subgroup of patients was studied with anal manometry before and after repair and with pudendal nerve terminal motor latency (PNTML) before surgery. Results were compared with a younger group of patients.
Between July 1986 and July 1991, 14 patients, ages ranging from 55 to 81, underwent anal sphincter reconstruction using an overlapping muscle repair. Ten patients were incontinent of solid stool and four of liquid stool. Improvement was seen in 13 of 14 patients: 7 (50 percent) complete control, 3 (21 percent) incontinent to flatus, and 4 (29 percent) incontinent to liquid stools (including the patient who failed to improve). Ten patients were studied with a continuous pull-out manometric technique and PNTML: one was not improved. There was minimum change in mean maximum resting pressure (35.0-37.9 mmHg). Mean maximum squeezing pressure increased from 66 to 75 mmHg overall. Patients with complete control had a mean maximum squeezing pressure of 81 mmHg compared with 60 mmHg in patients with residual incontinence. Mean anterior anal sphincter length increased from 2.92 cm to 3.31 cm. PNTML was normal (2.0 +/- 0.2) on one or both sides in all nine patients who improved (average, 2.1). The patient who failed to improve had abnormal nerve function bilaterally (2.4, 2.7).
Anal sphincter reconstruction can be performed in elderly patients with improvements in the majority of patients. Total control can be achieved by restoring maximum squeezing pressure in a patient with normal pudendal nerve function.
本研究旨在确定年龄增长是否会影响肛门括约肌重建术后的结果。
对55岁及以上患者进行的肛门括约肌重建术进行回顾，以确定功能结果是否受到年龄增长的不利影响。对一组亚组患者在修复前后进行肛门测压，并在手术前进行阴部神经终末运动潜伏期（PNTML）测定。将结果与年轻患者组进行比较。
1986年7月至1991年7月期间，14例年龄在55至81岁之间的患者接受了重叠肌肉修复肛门括约肌重建术。10例患者有固体粪便失禁，4例有液体粪便失禁。14例患者中有13例有改善：7例（50%）完全控制，3例（21%）有气体失禁，4例（29%）有液体粪便失禁（包括未改善的患者）。对10例患者采用连续拔出式测压技术和PNTML进行研究：1例未改善。平均最大静息压力变化最小（35.0 - 37.9 mmHg）。平均最大收缩压力总体上从66 mmHg增加到75 mmHg。完全控制的患者平均最大收缩压力为81 mmHg，而有残余失禁的患者为60 mmHg。肛门括约肌前平均长度从2.92 cm增加到3.31 cm。所有9例改善的患者中，一侧或双侧的PNTML正常（2.0 +/- 0.2）（平均，2.1）。未改善的患者双侧神经功能异常（2.4，2.7）。
老年患者可以进行肛门括约肌重建术，大多数患者有改善。对于阴部神经功能正常的患者，通过恢复最大收缩压力可以实现完全控制。
