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대둔근을 이용한 항문괄약근 재건술

Gluteus Maximus Transposition for Anal Incontinence

대한대장항문학회지 1997년 13권 1호 p.137 ~ 143
장지영 ( Jang Ji-Young ) - 조선대학교 의과대학 외과학교실

김정용 ( Kim Jung-Young ) - 조선대학교 의과대학 외과학교실
김권천 ( Kim Kweon-Cheon ) - 조선대학교 의과대학 외과학교실
민영돈 ( Min Young-Don ) - 조선대학교 의과대학 외과학교실
김성환 ( Kim Seong-Hwan ) - 조선대학교 의과대학 외과학교실

Abstract


Anal incontinence following pelvic trauma, surgery or neurologic disorder has significant medical and social implications. When no known functioning sphincter muscles are present, surgical correction of this distressing condition other than by
stomal fecal diversion is aimed at recreating a sphincter mechanism under voluntary control. The use of the gluteus maximus encircling the neorectum with a contractile muscualr ring provides an active control of continence and reserves the anorectal angulation. The sacrifice of the entire gluteus maximum muscle in an ambulatory patient will cause difficulty in climbing stairs; however, the use of the anatomically dissected lower half will preserve its function. With careful dissection, the lower half of the g1uteus maximus muscle together with its neurovascular supply can be developed for anal sphincter reconstruction. Three Patient, (two men and one woman) underwent g1uteus maximus transposition for complete anal incontinence. The indication for operation were sphincter destruction secondary to extensive soft tissue necrosis on perianal, perineal and buttock area due to necrotizing fascitis(n=2), and soft tissue defect on perianal, buttock
area due to trauma(n=1). The procedure is performed with the use of a diverting colostomy. The inferior portion of the origin of each gluteus maximus is detached from the sacrum and coccyx, bifurcated,and tunneled subcutaneously to encircle the anus. The ends were sutured together to form two opposing slings of voluntary muscles. Postoperatively two patient regained continence to solid stool, one to liquid stool as well. The technique of constructing sphincter is simple and utilizes principles of muscle tendon transfer without jeopardizing function of gait. Furthermore the gluteus maximus
muscle, being an accessory muscle of anal continence, is an ideal structure for this reconstruction.

키워드

Gluteus Maximus Muscle Transposition;Fecal Incontinence
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