Shafik A
Department of Surgery and Research, Faculty of Medicine, Cairo University, Egypt.
Am Surg. 1996 May;62(5):339-43.
Our recent studies have attributed fecal incontinence (FI) when it is associated with complete rectal prolapse (CRP) to pudendal neuropathy caused by pudendal canal syndrome (PCS). Herein we present the results of pudendal canal decompression (PCD), performed for the treatment of FI in 21 patients whose CRP was corrected by Ivalon sponge rectopexy 5.2 years before presentation. Thirteen patients had partial and eight complete FI. Examination revealed perianal hypoesthesia, diminished rectal neck pressure, reduced electromyographic (EMG) activity of both the external anal sphincter (EAS) and levator ani (LA) muscle, as well as prolonged pudendal nerve terminal motor latency (PNTML). PCD was performed with a mean follow up of 14.8 months. Postoperatively, seven (53.8%) of the patients with partial FI showed full fecal control with normalization or improvement of the perianal hypoesthesia, rectal neck pressure, EMG of EAS and LA, as well as PNTML. The remaining six patients were failures. Five (62.5%) of the eight patients with complete FI showed full fecal control, two partial improvement, and one failure. The degree of response of FI to PCD seems to be related to the degree of pudendal nerve damage. Nonimprovement may be due to irreversible pudendal nerve damage or incomplete PCD. In conclusion, PCD is effective in the treatment of FI associated with CRP, provided it is performed before complete nerve damage occurs.
我们最近的研究认为，当大便失禁（FI）与完全直肠脱垂（CRP）相关时，是由阴部管综合征（PCS）导致的阴部神经病变所致。在此，我们展示了对21例患者进行阴部管减压术（PCD）的结果，这些患者在就诊前5.2年因Ivalon海绵直肠固定术纠正了CRP。其中13例患者为部分性大便失禁，8例为完全性大便失禁。检查发现肛周感觉减退、直肠颈压力降低、肛门外括约肌（EAS）和肛提肌（LA）的肌电图（EMG）活动减弱，以及阴部神经终末运动潜伏期（PNTML）延长。进行PCD后的平均随访时间为14.8个月。术后，13例部分性大便失禁患者中有7例（53.8%）实现了完全控便，肛周感觉减退、直肠颈压力、EAS和LA的肌电图以及PNTML均恢复正常或有所改善。其余6例患者手术失败。8例完全性大便失禁患者中有5例（62.5%）实现了完全控便，2例部分改善，1例失败。FI对PCD的反应程度似乎与阴部神经损伤程度有关。无改善可能是由于阴部神经不可逆损伤或PCD不完全。总之，PCD对治疗与CRP相关的FI有效，前提是在神经完全损伤之前进行。
