Sato T, Konishi F
Department of Surgery, Jichi Medical School, Tochigi, Japan.
Surgery. 1996 Jun;119(6):641-51. doi: 10.1016/s0039-6060(96)80188-7.
The aim was to reconstruct the functional anus by using a transposed skeletal muscle with pudendal nerve anastomosis (PNA) after anorectal resection.
Transposition of the biceps femoris muscle (BFM) with PNA around the perineal colostomy was performed in 22 dogs. In the control group (n = 11) the BFM with its own nerve was used. Evaluation was done at 3 to 5 months after the operation.
A contraction with evoked potential on electrical stimulation of the pudendal nerve (22 of 22) and tonic electrical activity (10 of 10) were observed in the dogs with PNA but not in those without PNA. Increased electrical activity (6 of 6) and a reactive rise in the neoanal canal pressure (9 of 13) were seen just after the insertion of a microballoon in the dogs with PNA but not in those without PNA. The neoanal canal length was elongated, and the anorectal angle became acute on electrical stimulation in both groups. No difference was seen in the resting anal pressure between both groups. The pattern of actomyosin adenosine 5'-triphosphatase staining of the neosphincter with PNA converted from that of a BFM to that of the external anal sphincter. The defecatory status in the study group was better according to the evaluation of the feces on the cage floor.
Acceptable neoanal function was achieved through the sphincter reconstruction with PNA.
目的是在直肠切除术后通过使用带阴部神经吻合术（PNA）的转位骨骼肌重建功能性肛门。
对22只犬进行股二头肌（BFM）转位并在会阴结肠造口周围进行PNA。对照组（n = 11）使用带有自身神经的BFM。术后3至5个月进行评估。
在有PNA的犬中观察到阴部神经电刺激时出现诱发电位的收缩（22只中的22只）和紧张性电活动（10只中的10只），而在没有PNA的犬中未观察到。在有PNA的犬中，插入微球囊后立即出现电活动增加（6只中的6只）和新肛管压力反应性升高（13只中的9只），而在没有PNA的犬中未出现。两组在电刺激时新肛管长度均延长，肛管直肠角变锐。两组静息肛门压力无差异。有PNA的新括约肌的肌动球蛋白腺苷5'-三磷酸酶染色模式从BFM的模式转变为肛门外括约肌的模式。根据笼底粪便评估，研究组的排便状况更好。
通过PNA进行括约肌重建可实现可接受的新肛门功能。
