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目的:为了解决肛门直肠畸形术后大便失禁的问题。方法:对7例患儿行两侧臀大肌瓣移植括约肌重建术,其中高位畸形4例,中位畸形3例,年龄6～14岁。入院时有肛门口哆开、粘膜外翻、肛门收缩无力。根据便意的有无和大便失禁程度进行肛门功能临床评定,1分者3例,2分者4例。结果:无术后并发症,术后肛门功能明显改善,肛门口闭合或明显缩小,粘膜外翻消失或缩小,肛门收缩力增强,便意恢复正常,干便能控制,肛门功能临床评定为4～5分。6例获随访、最短3个月,最长7年半。除2例肛门口轻度哆开,粘膜部分外翻外,其余肛门外观基本正常。3例偶有污粪或稀便时失禁,临床评分5分,另3例肛门功能正常(6分)。其中4例进行肛门功能综合评定,均为优。结论:本手术是一种较理想的肛门外括约肌重建方法。
Objective: To solve the problem of fecal incontinence after anorectal malformations. Methods: Seven patients underwent bilateral sphincterotomy for sphincter reconstruction. Among them, 4 cases had high malformations, 3 cases had median malformations, and the age ranged from 6 to 14 years. Dodge anal opening when open, mucosal valgus, anal weakness. An anal function was evaluated according to the presence or absence of fecal incontinence and clinical evaluation of anal function in 3 patients with 1 point and 4 patients with 2 points. Results: No postoperative complications, anal function improved significantly, the anus closed or significantly reduced, disappearance or reduction of mucosal eversion, anal contractility increased, it means to return to normal, dry can control, clinical evaluation of anal function is 4 ~ 5 points. 6 cases were followed up, the shortest 3 months, up to 7 years and a half. In addition to 2 cases of mild anal duo open part of the mucosa valgus, the other basically the normal appearance of the anus. 3 cases of occasional stool or loose stool incontinence, the clinical score of 5 points, and the other 3 cases of normal anal function (6 points). Among them, 4 cases were evaluated for anal function comprehensively and were excellent. Conclusion: This operation is a better method of reconstruction of external anal sphincter.