Ecker K W, Hildebrandt U, Feifel G
Abteilung für Allgemeine Chirurgie, Abdominal- und Gefässchirurgie, Chirurgische Universitätsklinik Homburg/Saar.
Zentralbl Chir. 1996;121(8):681-7.
The surgical problems of traumatic sphincter lesions are reported comparing early and late repair. In 11 acute injuries the surgical concept consisted generally of proximal fecal deviation, distal washout, reconstruction of the muscular defects and presacral drainage. In soft tissue injuries (grade I, n = 2) complete healing without functional deficiencies was obtained inspite of renouncing fecal diversion. In isolated ruptures of the rectum or the sphincter (grade II, n = 3) and in complete disruption of both components (grade III, n = 4) after healing and closure of the temporary colostomy continence was estimated subjectively as being sufficient. Patients' overall-appraisal was not correlated to the preoperative degree of destruction not the postoperative measurement of continence. Only when devascularisation of the anorectum with severe bleeding had occurred (grade IV, n = 2) proctectomy was necessitated resulting in one death. In none of 5 patients operated on elsewhere there was a chance of secondary sphincteric reconstruction. During operation or endosonographically and electromyographically the sphincter musculature could not be detected. Obviously renouncing of anatomical reconstruction leads not only to retraction but also to secondary degeneration of the sphincter muscles.
报告了创伤性括约肌损伤的手术问题，并比较了早期和晚期修复情况。在11例急性损伤中，手术理念通常包括近端粪便改道、远端冲洗、肌肉缺损重建和骶前引流。在软组织损伤（I级，n = 2）中，尽管放弃了粪便转流，但仍实现了完全愈合且无功能缺陷。在直肠或括约肌的孤立破裂（II级，n = 3）以及两者均完全断裂（III级，n = 4）的情况下，在临时结肠造口愈合关闭后，主观评估控便功能足够。患者的总体评价与术前破坏程度以及术后控便测量均无相关性。仅当发生伴有严重出血的直肠肛门血管化缺失（IV级，n = 2）时，才需要进行直肠切除术，导致1例死亡。在其他地方接受手术的5例患者中，均没有进行二次括约肌重建的机会。在手术过程中或通过内镜超声和肌电图检查，均无法检测到括约肌肌肉组织。显然，放弃解剖重建不仅会导致括约肌回缩，还会导致其继发性退变。
