Lehur P A, Bruley des Varannes S, Dutre J, Guiberteau-Canfrère V, Galmiche J P, Le Borgne J
Clinique Chirurgicale II, Hôpital G.R. Laennec, Nantes.
Ann Chir. 1995;49(7):621-7.
Optimal surgical treatment for neuropathic severe anal incontinence is still controversial: the combination of pre-anal levator plication and post-anal repair (Parks) has been recently described. This non-randomized prospective study evaluated the results of pre- and post-anal repair for medically non-corrected neuropathic and traumatic anal incontinence. Ten female patients (mean age: 59) were operated by pre- and post-anal levatorplasty (total pelvic floor repair). Incontinence was scored clinically according to the Jorge and Wexner score (normal: 0, max.: 20) and with no rectal manometry, before and after surgery. Fourteen months after surgery (range: 9-18 months), anal continence for stools was achieved in 7 out of 10 patients: the patients clinical scores decreased from 15 (12-19) pre-operatively to 6 (1-18) post-operatively (p < 0.01) (4 for good results, 17 for the 3 failures). No manometric parameter was able to predict or explain postoperative functional results. Only anal canal length and maximal amplitude of anal contractions were significantly improved from 3.0 cm (2.0-4.0) to 3.5 cm (2.2-4.5), p < 0.05) for the former and from 54 to 69 cm H2O for the latter (p < 0.05). In this small series, pre- and post-anal levatorplasty effectively corrected severe neuropathic anal incontinence in the short-term, in 70% of cases. In our experience, this technique appears to be superior to post-anal repair, without increasing technical problems or morbidity.
最近有人描述了肛门前耻骨直肠肌折叠术和肛门后修复术（帕克斯手术）的联合应用。这项非随机前瞻性研究评估了肛门前后修复术治疗药物治疗无效的神经病理性和创伤性肛门失禁的效果。10名女性患者（平均年龄：59岁）接受了肛门前后耻骨直肠肌成形术（全盆底修复术）。在手术前后，根据豪尔赫和韦克斯纳评分（正常：0分，最高：20分）对失禁情况进行临床评分，且未进行直肠测压。术后14个月（范围：9 - 18个月），10名患者中有7名实现了大便自控：患者的临床评分从术前的15分（12 - 19分）降至术后的6分（1 - 18分）（p < 0.01）（4例效果良好，3例失败评分为17分）。没有任何测压参数能够预测或解释术后的功能结果。仅肛管长度和肛门收缩最大幅度有显著改善，前者从3.0厘米（2.0 - 4.0厘米）增至3.5厘米（2.2 - 4.5厘米），p < 0.05，后者从54厘米水柱增至69厘米水柱（p < 0.05）。在这个小样本系列中，肛门前后耻骨直肠肌成形术在短期内有效矫正了70%病例的重度神经病理性肛门失禁。根据我们的经验，这项技术似乎优于肛门后修复术，且不会增加技术难题或发病率。
