Krebs C, Acuña R
Department of Pediatric Surgery, Roberto del Rio Hospital Center, Santiago, Chile.
Eur J Pediatr Surg. 1994 Jun;4(3):151-7. doi: 10.1055/s-2008-1066090.
From October 1, 1981, until December 31, 1991, we performed clinical, radiological, electromanometrical, histochemical and histological diagnostic procedures in 906 patients under 15 years of age, because of several distinct colonic and anorectal disorders. 739 were clinically constipated and in 272 of them hypertonicity of the internal anal sphincter with or without achalasia could be demonstrated by manometry. 121 of these patients were submitted to a posterior, transanal, partially resective internal sphincteromyomectomy, according to a slightly modified classical procedure. Follow-up of our operated patients ranged from 1 month to 9 years, with a mean of 3 years and 2 months and overall satisfactory results in 87.6% based on clinical evaluation. Additionally, 55.4% of the operated patients had early postoperative manometric controls (n = 67) and 77.6% of these (n = 52) accepted a third manometry, in order to evaluate late results of our procedure. We could demonstrate that early postoperative anorectal electromanometry shows a highly significant decrease of the internal anal sphincter pressure correlating with a clinical improvement in 98.5% of these patients (n = 67). Most late postoperative examinations showed recurrent elevation of the manometric internal sphincter pressure parameters, exceeding the mean values of our own normal controls. Nevertheless, clinically 98.1% of these patients had a persistent satisfactory remission of their symptoms, thus not correlating with the manometric findings in these cases. We conclude, that transanal internal sphincter myomectomy is a safe surgical procedure, which leads to satisfactory results in approximately 90% of chronically constipated children with anal sphincter hypertonicity, if very precise indications for operation are considered.
从1981年10月1日至1991年12月31日，我们对906名15岁以下因多种不同结肠和肛肠疾病的患者进行了临床、放射学、电子测压、组织化学和组织学诊断程序。739例临床上有便秘症状，其中272例通过测压可显示肛门内括约肌张力亢进，伴或不伴有失弛缓症。根据略有改良的经典手术方法，对其中121例患者实施了经肛门后路部分切除性内括约肌肌切除术。我们对接受手术的患者随访时间为1个月至9年，平均3年零2个月，基于临床评估，总体满意率为87.6%。此外，55.4%的接受手术患者进行了术后早期测压对照（n = 67），其中77.6%（n = 52）接受了第三次测压，以评估我们手术的远期效果。我们可以证明，术后早期肛肠电子测压显示肛门内括约肌压力显著降低，98.5%的这些患者（n = 67）临床症状改善与之相关。大多数术后远期检查显示测压的肛门内括约肌压力参数再次升高，超过了我们自身正常对照的平均值。然而，临床上这些患者中有98.1%症状持续得到满意缓解，因此在这些病例中与测压结果不相关。我们得出结论，如果考虑非常精确的手术指征，经肛门内括约肌肌切除术是一种安全的手术方法，对于约90%患有肛门括约肌张力亢进的慢性便秘儿童可取得满意效果。
