Konsten J, Baeten C G, van Mameren H, Havenith M G, Soeters P B
Department of Surgery, Maastricht University Hospital, The Netherlands.
Dis Colon Rectum. 1993 Mar;36(3):247-53. doi: 10.1007/BF02053505.
To develop surgical techniques to obtain stoma continence with a muscular sphincter, the anatomy (especially innervation and vascularization patterns) of the human abdominal wall muscles was studied in three cadaver dissections. It was found that transposed rectus abdominis muscle might be positioned as a new sphincter (sphincteroplasty). Next, the feasibility was assessed in six pigs, and the rectus muscle was positioned as a sphincter around a Thiry Vella loop. The use of three different surgical procedures has been assessed: 1) a muscular ring of the proximal rectus was constructed and partly denervated the muscle; 2) the distal end of the Thiry Vella loop was pulled through the middle of the rectus muscle, thereby also introducing partial muscle denervation; and 3) a sling was constructed using the distal muscle part. In four of these six pigs, identical procedures were performed also at the left side. These new sphincters were electrically stimulated (with implanted stimulation devices) to study the feasibility of prolonged sphincter contraction independent of will. Stimulation with a frequency of 25 Hz was used at the right and 2 Hz was used at the left sphincters. It was found that electrical stimulation with a frequency of 25 Hz as well as 2 Hz increased the percentage of Type I (relatively fatigue-resistant) muscle fibers significantly from 42 to 65 percent (n = 6) in the right and from 50 to 67 percent (n = 4) in the left rectus muscle into innervated muscle areas of the sphincters. This increase is considered essential for sustained sphincter function. Stoma continence was not achieved because constructing muscular rings (as a sphincter) caused partial atrophy. Construction of a sling using the distal part of the rectus did not cause substantial atrophy, but continence was not achieved because the dorsal side of the Thiry Vella loop was not completely covered with muscle fibers.
为了开发利用肌肉括约肌实现造口节制的手术技术，在三具尸体解剖中研究了人腹壁肌肉的解剖结构（尤其是神经支配和血管分布模式）。发现移位的腹直肌可作为新的括约肌进行定位（括约肌成形术）。接下来，在六头猪身上评估了其可行性，并将腹直肌围绕Thiry Vella袢定位为括约肌。评估了三种不同的手术方法：1）构建近端腹直肌的肌环并对肌肉进行部分去神经支配；2）将Thiry Vella袢的远端穿过腹直肌中部，从而也引入部分肌肉去神经支配；3）使用腹直肌远端部分构建吊带。在这六头猪中的四头，左侧也进行了相同的手术。对这些新的括约肌进行电刺激（使用植入式刺激装置），以研究不依赖意志的括约肌长时间收缩的可行性。右侧括约肌使用25 Hz的频率进行刺激，左侧括约肌使用2 Hz的频率进行刺激。结果发现，25 Hz和2 Hz的电刺激均使右侧腹直肌进入括约肌神经支配肌肉区域的I型（相对抗疲劳）肌纤维百分比从42%显著增加到65%（n = 6），左侧从50%增加到67%（n = 4）。这种增加被认为对持续的括约肌功能至关重要。由于构建肌环（作为括约肌）导致部分萎缩，未实现造口节制。使用腹直肌远端构建吊带未导致明显萎缩，但由于Thiry Vella袢的背侧未完全被肌纤维覆盖，未实现节制。
