산과적 변실금에서 괄약근전방복원술의 성적에 영향을 미치는 요인
Predictors of Outcome Following Anterior Sphincter Repair in Obstetric Fecal Incontinence
이상전,
소속 상세정보
이상전 ( Lee Sang-Jeon )
Chungbuk National University
KMID : 0356720050210050279
Abstract
Purpose: This study was designed to evaluate the outcome of anterior sphincter repair and factors influencing the outcome in patients with obstetric fecal incontinence.
Methods: Thirty-three patients undergoing sphincter repair for obstetric fecal incontinence were prospectively evaluated. Preoperatively, standardized interviews and physiologic studies were performed. The severity of incontinence was graded according to the Parks´ classification. Patients´ satisfaction was classified as excellent, good, fair, and no improvement. An anterior overlapping sphincteroplasty was performed with or without levatorplasty. Interviews and manometry were repeated three months after the operation. Four years after the operation, the severities of incontinence and patients´ satisfaction were reevaluated.
Results: Preoperatively, all patients showed high-grade incontinence (grade 3 or 4). Three months after the operation, 28 patients (84.8%) had successfully recovered continence (incontinence grade 1 or 2), and 25 of those patients (75.8%) replied with satisfaction (excellent or good). The maximal average squeeze pressure (MASP) and the high-pressure zone (HPZ) length, but not the maximal average resting pressure (MARP), had significantly increased in patients with successfully recovered continence. At the 4-year follow ups, the outcomes were significantly worse than thase at 3 months, but 24 patients (72.7%) still maintained good outcome, and 25 patients (66.7%) still replied with satisfaction that was not significantly worse than that at 3 months. Patients with a young age (＜45 years), a shorter duration of incontinence (＜10 years), a larger increase in MASP or MASP at 3 months after the operation, no pudendal neuropathy, and a good result at 3 months were more likely to maintain low-grade incontinence. The addition of levatorplasty and an increase in the HPZ length at 3 months did not affect the outcome.
Conclusions: At the 4-year follow-ups, the outcomes had significantly deteriorated, but patients´ satisfaction had not. Age, the duration of incontinence, a postoperative increment in MASP or MASP, pudendal neuropathy, and a short-term good outcome were closely related to the long-term outcome. J Korean Soc Coloproctol 2005;21: 279-285
키워드
산과적 변실금;괄약근전방복원술
Obstetric fecal incontinence;Anterior sphincter repair
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