Lin C L, Chen C C
Department of Surgery, National Taiwan University & Hospital, Taipei, ROC.
J Formos Med Assoc. 1996 Apr;95(4):303-7.
Rectoanal sphincteric inhibitory reflex and continence were evaluated in 23 patients with high and intermediate imperforate anus who underwent posterior sagittal anorectoplasty from 1985 to 1993. The postoperative anorectal function was followed both manometrically and clinically at regular intervals. The presence of the reflex was positively related to postoperative continence in patients older than 4 years but not in younger patients. Two patients with a rectoprostate fistula after an internal sphincter saving procedure had unsatisfactory results. Seven of nine patients with a blind rectal pouch, whose distal rectal end (where the internal sphincter lies) was partially excised or trimmed during reconstruction, had fair postoperative defecation. The internal sphincter saving procedure is helpful but it does not seem essential for the development of continence. The fact that patients with a negative reflex turned out to have a positive reflex 7 to 33 months after the initial test suggested that the rectum or perirectal tissue had recovered from surgical trauma. Time and age are important factors in clinical evaluation and interpretation of manometric results.
1985年至1993年间，对23例高位和中位肛门闭锁患者进行了后矢状入路肛门直肠成形术，并评估了其直肠肛门括约肌抑制反射和控便能力。术后定期通过测压法和临床方法对肛门直肠功能进行随访。4岁以上患者的反射存在与术后控便能力呈正相关，而4岁以下患者则不然。2例在保留内括约肌手术后出现直肠前列腺瘘的患者，结果不理想。9例直肠盲袋患者中有7例，其重建过程中远端直肠末端（内括约肌所在处）被部分切除或修整，术后排便情况尚可。保留内括约肌手术是有帮助的，但对于控便能力的发展似乎并非必不可少。初次测试为阴性反射的患者在7至33个月后出现阳性反射，这一事实表明直肠或直肠周围组织已从手术创伤中恢复。时间和年龄是临床评估和解释测压结果的重要因素。
