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- Anorectal Malformations-Update 1998
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題 名 | Anorectal Malformations-Update 1998=鎖肛症的最新發展 |
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作 者 | 林哲男; | 書刊名 | 長庚醫學 |
卷 期 | 21:3 1998.09[民87.09] |
頁 次 | 頁237-250 |
分類號 | 416.245 |
關鍵詞 | 鎖肛症; 後矢狀面直腸肛門成形術; 排便控制; 生理回饋治療; Malone闌尾造口術; Anorectal malformations; Posterior sagittal anorectoplasty; Fecal continence; Biofeedback therapy; Malone continent appendicostomy; |
語 文 | 英文(English) |
中文摘要 | 鎖肛症的發生率並不太低,大約4至5千活產中即有一例。其治療仍是小兒外科醫 師極大挑戰,因為這是一種功能性的手術。本院在1977年至1997年的20年間治療了約400例 的鎖肛症。在1985年以前手術是依高、中、低位鎖肛症而有不同。對低位者常用 cut back 或移位肛門形成術。而對中、高位者則用腹部會陰肛門形成術或薦骨會陰肛門形成術(或其 他改良術式),但自1985年後本院則以單一術式,即後矢狀面直腸肛門成形術(PSARP),治療 所有各種鎖肛症。166例是全新病例,而34例則為再度施行手術者。PSARP最大的優點為術者 可以直視下,依解剖學構造來修復�硎煄A並有效應用存在的排便控制肌肉。另一優點則為以 單一的後矢狀面皮膚切開,做不同程度擴約肌、提肛肌切割,各種不的鎖肛症都可以以相同 的術式做手術治療。雖然長期排便控制機能的追蹤仍不能證明有較佳的結果,但肛門的外觀 較正常及術後的併發症較少則為大部分小兒科外科醫師所承認。但是無論如何治療,仍有 10%至30%的病童有排便失禁現象。現階段只能每天以大量灌腸來清除結腸及直腸糞便,使病 童得保持12至24小時的乾淨而有較正常的社會生活。最近「生理回饋訓練」應用較方便的電 腦及肛門動力檢查設施,似有不錯的效果。我們回顧過去400例鎖肛症治療經驗來探討排便 控制機轉及手術結果,並做文獻回顧。 |
英文摘要 | Anorectal malformation is a common congenital anomaly. Its correction still challenges the wisdom and expertise of the pediatric surgeon. From 1977 through 1997, approximately 400 cases of this anomaly were treated at this institution. Prior to 1985, cut-back anoplasty and translocation anoplasty were the treatments of choice for the low anomalies, and abdominoperineal pull-through anoplasty or sacroperineal anoplasty (and their modifications) prefered for the intermediate or high defects. Since 1985, posterior sagittal anorectoplasty (PSARP) has been adopted exclusively as the operative procedure for the correction of the entire spectrum of anorectal malformations. Two hundred patients have undergone this procedure either primarily (N=166) or secondarily (N=34). PSARP is a procedure which enables the surgeon to repair the pelvic anatomy under direct vision, maximally utilizing all the existing continence muscles and hence resulting in better fecal continence. With minimal, limited or maximal division of the continence muscles under one same skin incision, the entire spectrum of this defect can be repaired. The result of cosmesis is generally regarded as better, and the immediate postoperative complicationsare are fewer. In spite of all efforts, 10 to 30% of patients still suffer from total fecal incontinence which is intractable to all kinds of medicanons and enemas. A bowel management program with large volume enemas, either throug the Anus or a Malone appendicostomy, retrogradely or antegradely, to wash out stool in the colon and rectum may be necessary to keep the patient clean and more socially acceptable. Biofeedback therapy offers another alternative of improve continence with the development of better computer systems and manometry equipment. This review provides a new concept of the fecal continence mechanism and an operative procedure for constructing a new anorectum based on this concept for the treatment of patients with anorectal malformations. |
本系統中英文摘要資訊取自各篇刊載內容。