Experimental study of reconstruction of the external anal sphincter using the gracilis muscle with the pudendal nerve transplantation.

概要

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The gracilis muscle transplantation for patients with anal incontinence has been reported since Pickrell, but the tesults are not satisfactory. In this study, the pudendal nerve was experimentally transplanted into gracilis muscle to get physiological function same as the external anal sphincter. <BR>The gracilis muscle showed 55.8% of type 1, 12.6% of type 2A, 30.9% of type 2B and 0.7% of type 2C fiber distribution in ATPase stain. In contrast, the external anal sphincter showed 0.9% of type 1, 98.4% of type 2A and 0.7% of type 2C and type 2B fiber was not seen. Two weeks after the pudendal nerve transplantation, almost all fibers of the gracilis muscle changed into type 2C which were said to be primitive. After 3 weeks, type 2B fiber disppeared and 95.2% of type 2A fiber was seen. After 8 weeks, the gracilis muscle got to have almost the same fiber type distribution as the external anal sphincter. <BR>Electromyographically, 4 weeks after the pudendal nerve transalantation the gracilis muscle showed contraction M wave with the stimulation of the transalanted pudendal nerve. <BR>Therefore, it may be possible to reconstruct the similar muscle functioning same as the original external anal sphincter.
日本大腸肛門病学会の論文