산과적 손상에 의한 변실금에 대한 괄약근 복원술
Sphincter Repair for Fecal Incontinence after Obstetric Injury
안광우, 이상전, 박진우,
소속 상세정보
안광우 ( Ahn Kwang-Woo )
Chungbuk National University
이상전 ( Lee Sang-Jeon )
Chungbuk National University
박진우 ( Park Jin-Woo )
Chungbuk National University
KMID : 0356719990150010009
Abstract
Purpose: We designed this study to evaluate efficacy of sphincter repair and factors influencing in patients with postobstetric fecal incontinence.
Methods: Twenty-one patients (mean age42 years; range 23∼67) undergoing sphincter repair for postobstetric fecal incontinence (mean duration 12 years; range 6 months∼46 years) were evaluated prospectively. Preoperatively, standardized interviews, anorectal manometry and measure ment of pudendal nerve terminal motor latency (PNTML) were performed. Incontinence was graded according to the Parks’ classification: Grade 1 - continence to stool and flatus; Grade 2 - incontinent to flatus, some urgency to stool present but no incontinence; Grade 3 - incontinent to liquid stool; Grade 4 - incontinent to formed stool. Sphincter repair methods were overlap repair of external anal sphincter (EAS) in 4 patients, overlap repair of EAS with anterior levatorplasty in 15 patients, and overlap repair of EAS with anterior levatorplasty and postanal repair in 2 patients. Anorectal manometry at 3 months, and interviews at 3 months and 6 months after sphincter repair were performed again. Patients’ satisfaction was classified as excellent, good, fair, and no improvement.
Results: Difficulty in first delivery was noticed in 18 patients and history of previous sphincter repair was noticed in 5 patients. Preoperatively, most patients showed high grade incontinence (grade 3 in 13 and grade 4 in 8 patients). After sphincter repair, 18 patients (85.7%) became grade 1 or 2, and 16 patients (76.2%) replied their functional satisfaction excellent or good.There were no difference between the results at 3 months and 6 months. Poor functional outcome was in 2 of 3 patients with bilaterally prolonged preoperative PNTML. Short duration of incontinence and young age at the time of repair favored good results. Previous sphincter repair did not influence the outcome. Postoperatively both anal pressure and high pressure zone length were significantly increased in patients with improved continence. Postoperative complications were wound infection in 2 patients and necrosis at the apex of the advancement skin flap in 1 case
but these did not influence the outcome.
Conclusion: Most postobstetric fecal incontinence can be successfully treated with sphincter repair. Excellent results are expected when the duration of incontinence is short and the patients are young. Pudendal neuropathy seemed to be related to poor outcome.
키워드
Sphincter repair;Fecal incontinence;Obstetric injury
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