Felt-Bersma R J, Cuesta M A, Koorevaar M
Department of Surgery, Vrije Universiteit, University Hospital, Amsterdam, The Netherlands.
Dis Colon Rectum. 1996 Aug;39(8):878-85. doi: 10.1007/BF02053986.
This study investigated the effect of anal sphincter repair on fecal continence in relation to anal endosonography and anal manometry.
Eighteen patients (7 male, 11 female) with anal sphincter defects and complaints of fecal incontinence (5), soiling ( = liquid discharge; 3), or both (10) were studied before and after sphincter repair with endosonography and anal manometry. Complaints were the result of obstetric trauma (7), surgical trauma (7), both (3), and other trauma (1). Five patients had previous surgery. Preoperative endosonography showed a defect of both sphincters in nine patients, a defect of the external anal sphincter in five patients, and a defect of the internal anal sphincter in four patients. An overlapping sphincter repair was performed.
Postoperatively and subjectively (S; patient's view), 13 (72 percent) patients became continent or improved; in 5 (28 percent) patients the complaints were unaltered. Objectively (O) (incontinence or soiling frequency), these figures were 12 (67 percent) and 6 (33 percent). Postoperative endosonographic images improved in 14 (78 percent) patients; defects of the sphincters (almost) disappeared (4) or were smaller (10). In the other four patients, images were unchanged. In two patients, overlapping of the muscle was clearly visible with anal endosonography. Clinical result (subjective (S) and objective (O)) of sphincter repair correlated with changes in anal endosonography (S, r = 0.64, P < 0.004; O, r = 0.51, P = 0.03) and anal manometry (S, r = 0.54, P = 0.038; O, r = 0.44, P = 0.09 (not significant)) and not with pudendal nerve latency.
In 78 percent of our patients, endosonographic sphincter defect had diminished or disappeared after sphincter repair. There was a good correlation between clinical effect of sphincter repair and changes with anal endosonography and anal manometry. Postoperative persistent incontinence is attributable to remaining sphincter defects. Anal endosonography should be performed as a routine procedure in patients with fecal incontinence or soiling, also after failed surgery.
本研究调查了肛门括约肌修复术对大便失禁的影响，并与肛门内超声检查和肛门测压进行关联分析。
18例肛门括约肌缺陷患者（男7例，女11例），有大便失禁主诉（5例）、便污（即液体流出；3例）或两者皆有（10例），在括约肌修复术前及术后接受了内镜超声检查和肛门测压。这些主诉由产科创伤（7例）、手术创伤（7例）、两者皆有（3例）及其他创伤（1例）导致。5例患者曾接受过手术。术前内镜超声检查显示，9例患者内外括约肌均有缺陷，5例患者肛门外括约肌有缺陷，4例患者肛门内括约肌有缺陷。均进行了重叠式括约肌修复术。
术后主观上（S；患者观点），13例（72%）患者大便失禁情况改善或恢复正常；5例（28%）患者的症状未改变。客观上（O）（失禁或便污频率），相应数据分别为12例（67%）和6例（33%）。术后14例（78%）患者的内镜超声图像有所改善；括约肌缺陷（几乎）消失（4例）或变小（10例）。另外4例患者图像未改变。2例患者的肌肉重叠在肛门内镜超声检查中清晰可见。括约肌修复术的临床结果（主观（S）和客观（O））与肛门内镜超声检查的变化相关（S，r = 0.64，P < 0.004；O，r = 0.51，P = 0.03）以及与肛门测压相关（S，r = 0.54，P = 0.038；O，r = 0.44，P = 0.09（无统计学意义）），与阴部神经潜伏期无关。
在我们的患者中，78%在括约肌修复术后内镜超声显示的括约肌缺陷减轻或消失。括约肌修复术的临床效果与肛门内镜超声检查及肛门测压的变化之间存在良好相关性。术后持续性失禁归因于括约肌缺陷仍然存在。对于大便失禁或便污患者，即使手术失败后，肛门内镜超声检查也应作为常规检查。
