van Tets W F, Kuijpers J H
Department of Surgery, Lukas-Andreas Hospital, Amsterdam, The Netherlands.
Dis Colon Rectum. 1998 Mar;41(3):365-9. doi: 10.1007/BF02237493.
Postanal repair was designed to restore both anatomy and function of the anal canal in neurogenic fecal incontinence. In most series, the degree of continence is improved in fewer than 50 percent of patients. Adding anterior levatorplasty and sphincter plication (total pelvic floor repair) is claimed to improve functional results. We performed a randomized trial comparing postanal and total pelvic floor repair for neurogenic incontinence.
Twenty female patients were studied. All had Type D incontinence (Parks and Browning). Anal manometry, defecography, and grading of the degree of continence were repeated 12 weeks after surgery to assess changes in clinical, manometric, and radiologic parameters. Statistical analysis was done using Wilcoxon's signed-rank test and Wilcoxon's two-sample test.
Continence improved in eight patients. Differences among clinical, manometric, and radiologic data were not statistically significant.
Pelvic floor repair procedures produce no consistent changes in anatomy or physiology. Clinical improvement is caused by creation of a local stenosis or by the placebo effect rather than by improvement of muscle function.
肛门后修复术旨在恢复神经源性大便失禁患者肛管的解剖结构和功能。在大多数病例系列中，不到50%的患者控便程度得到改善。有人声称增加前耻骨直肠肌成形术和括约肌折叠术（全盆底修复术）可改善功能效果。我们进行了一项随机试验，比较肛门后修复术和全盆底修复术治疗神经源性失禁的效果。
对20名女性患者进行了研究。所有患者均为D型失禁（帕克斯和布朗宁分类法）。术后12周重复进行肛门测压、排粪造影及控便程度分级，以评估临床、测压和放射学参数的变化。采用威尔科克森符号秩检验和威尔科克森两样本检验进行统计学分析。
8例患者控便情况改善。临床、测压和放射学数据之间的差异无统计学意义。
盆底修复手术在解剖结构或生理功能方面未产生一致的变化。临床改善是由局部狭窄的形成或安慰剂效应引起的，而非肌肉功能的改善。
