直腸肛門奇形症例における術後排便機能評価法に関する研究

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Postoperative anal continence after surgical correction of anorectal anomalies was evaluated with clinical and objective assessments. Clinical assessments was done with a modification of the system developed by Kelly, and objective assessment was based on both manometric and radiologic studies. In radiologic studies, attention was paid to the presence of leakage of the contrast medium and of anterior angulation of the rectum. Manometric studies were performed by an open-tip method with a continuous infusion system. The probe was withdrawn at a constant speed and an anorectal pressure profile was recorded. The manometric data were analyzed with regard to three factors: 1. amplitude of ano-rectal pressure difference : 2. length of high pressure zone: and 3. presence of anorectal reflex. Patients with translevator anomalies treated with perineal anoplasty were excellent both in clinical and objective scores. But discrepacies between these scores were observed in patients with supralevator anomalies. It was shown that they had high clinical scores in spite of low scores by objective means, and a serial analysis of these cases with clinical assessment showed that fecal continence improved in a time course of follow up and was established finally after the patients went through puberty. In the case of supralevator anomalies, patients treated with sacroperineal pull-through showed better results with respect to objective assessment than those treated with abdomino-perineal or abdomino-sacroperineal pull-through. It was concluded that objective assessment, consisting of manometric and radiologic studies, would be more valuable than clinical assessment in evaluating postoperative anorectal functions and operative procedures.
日本小児外科学会の論文
1983-08-20

直腸肛門奇形症例における術後排便機能評価法に関する研究

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