摘要目的:为了解决肛门直肠畸形术后大便失禁的问题.方法:对7例患儿行两侧臀大肌瓣移植括约肌重建术,其中高位畸形4例,中位畸形3例,年龄6～14岁.入院时有肛门口哆开、粘膜外翻、肛门收缩无力.根据便意的有无和大便失禁程度进行肛门功能临床评定,1分者3例,2分者4例.结果:无术后并发症,术后肛门功能明显改善,肛门口闭合或明显缩小,粘膜外翻消失或缩小,肛门收缩力增强,便意恢复正常,干便能控制,肛门功能临床评定为4～5分.6例获随访、最短3个月,最长7年半.除2例肛门口轻度哆开,粘膜部分外翻外,其余肛门外观基本正常.3例偶有污粪或稀便时失禁,临床评分5分,另3例肛门功能正常(6分).其中4例进行肛门功能综合评定,均为优.结论:本手术是一种较理想的肛门外括约肌重建方法.

abstractsObjectives Seven cases(aged 6-14yrs)of anal atresia(high 4,middle.3)with postoperative fecal incontinence are reported.On admission,patients had anal relaxation and mucosal prolapse.The anal function was scored as 1(3 cases)and 4(2 cases)according to bowel sensation and fecal incontinence.All patients underwent transplantation of muscle flaps by bilateral gluteus maximum muscles without any complication.After operation,the anal contraction improved,mucosal prolapse disappeared and the bowel sensation recovered.The anal function was scored as 4-5.Six patients were followed-up for 3 months to 7.5yrs.of them.3 had normal anal function(score of 6),and 3 had occasional fecal soiling(score of 5).The authors consider this is a better and ideal technique of anal sphincter reconstruction.