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目的:探讨儿童肛门失禁及臀大肌瓣肛门括约肌成形术治疗肛门失禁的机制。方法:采用一种半导体力敏式测压仪对正常儿童、各种原因的肛门失禁及肛门失禁行臀大肌瓣肛门括约肌成形术后患儿进行静态、动态及模拟状态下的测压。结果:失禁者肛管最大拖出力明显降低(P<0.005);反映横纹肌功能的球海绵体肌反射、肛皮反射及主动收缩均明显降低或缺乏(P<0.05);最低感觉气量明显升高,尤其是在骶脊膜膨出失禁组(P<0.001);行臀大肌瓣肛门括约肌成形术后以上指标均有不同程度的改善。结论:提示不同原因所致的肛门失禁机制不完全相同,臀大肌瓣肛门括约肌成形术改善肛门控制在于增加肛管长度、恢复了肛管感觉、建立了主动意识控制。
Objective: To explore the mechanism of anal incontinence and anal sphincteroplasty in the treatment of anal incontinence in children. Methods: A kind of semiconductor force-sensitive manometry instrument was used to measure static pressure, dynamic pressure and simulated pressure in normal children, anus incontinence and anal incontinence anal sphincteroplasty. Results: The maximal drag-out force of anal canal in incontinent persons decreased significantly (P <0.005). The muscle reflex, anal reflex and active contractions of sphenoid muscles reflecting striated muscle function were significantly reduced or absent (P <0.05) , Especially in the sacral meningioma group (P <0.001). All the above indexes were improved to some extent after the anal sphincteroplasty of the gluteus maximus flap. Conclusions: It is suggested that anal incontinence mechanism caused by different reasons is not completely the same. Anal sphincteroplasty with gluteus maximus flap improves anal length by increasing anal canal length, restoring anal canal sensation and establishing active consciousness control.