Ternent C A, Shashidharan M, Blatchford G J, Christensen M A, Thorson A G, Sentovich S M
Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska 68131, USA.
Dis Colon Rectum. 1997 Apr;40(4):462-7. doi: 10.1007/BF02258393.
This study was undertaken to evaluate endosonographic and physiologic determinants of fecal continence after sphincteroplasty.
Sixteen female patients with severe fecal incontinence were treated with overlapping sphincteroplasty. Mean postoperative follow-up was 12 (range, 3-48) months. All patients underwent preoperative and postoperative transanal endosonography and anal manometry. Bilateral pudendal nerve terminal motor latency determinations were performed in each patient. A physiologic continence score was used to assess stool control.
Postoperatively, continence was worse, unchanged, and improved in one, five, and ten patients, respectively. An inverse correlation was noted between endosonographic sphincter discontinuity postoperatively, in degrees, and the change in fecal continence after overlapping sphincteroplasty (r = -0.51; P = 0.04). Postoperative increases in sphincter resting (r = 0.6; P = 0.02) and squeeze (r = 0.54; P = 0.03) pressures correlated with improved fecal continence. Mean pudendal nerve terminal motor latency (r = -0.34; P = 0.20) and changes in anal sphincter length at rest (r = 0.41; P = 0.11) and squeeze (r = 0.33; P = 0.20) after sphincteroplasty did not significantly correlate with the change in continence. Patients with intact endosonographic anatomy postoperatively and bilateral, unilateral, or no evidence of pudendal neuropathy had a mean change in continence score of 0.5, 1.8, and 2.2, respectively (P = 0.48).
Endosonography after sphincteroplasty can identify residual sphincter defects that are significant in terms of fecal continence. Restoration of anal canal resting and squeeze pressures was related to improved fecal control after overlapping sphincteroplasty. Mean pudendal nerve terminal motor latency was not significantly related to poor postoperative continence. A trend toward less improvement in fecal continence was noted with bilateral pudendal neuropathy.
本研究旨在评估括约肌成形术后大便失禁的内镜超声和生理决定因素。
16例严重大便失禁的女性患者接受了重叠括约肌成形术治疗。术后平均随访时间为12（范围3 - 48）个月。所有患者均接受术前和术后经肛门内镜超声检查及肛门测压。对每位患者进行双侧阴部神经终末运动潜伏期测定。采用生理失禁评分评估大便控制情况。
术后，分别有1例、5例和10例患者的失禁情况变差、无变化和改善。术后内镜超声显示的括约肌连续性程度与重叠括约肌成形术后大便失禁的变化呈负相关（r = -0.51；P = 0.04）。术后括约肌静息压（r = 0.6；P = 0.02）和收缩压（r = 0.54；P = 0.03）的升高与大便失禁改善相关。括约肌成形术后平均阴部神经终末运动潜伏期（r = -0.34；P = 0.20）以及静息时（r = 0.41；P = 0.11）和收缩时（r = 0.33；P = 0.20）肛门括约肌长度的变化与失禁变化无显著相关性。术后内镜超声解剖结构完整且双侧、单侧或无阴部神经病变证据的患者，其失禁评分的平均变化分别为0.5、1.8和2.2（P = 0.48）。
括约肌成形术后的内镜超声检查可识别出对大便失禁有显著影响的残余括约肌缺陷。重叠括约肌成形术后肛管静息压和收缩压的恢复与大便控制改善有关。平均阴部神经终末运动潜伏期与术后失禁不佳无显著相关性。双侧阴部神经病变患者大便失禁改善趋势较小。
