Novel Applications of Sarcomere Length to Improve Anal Continence

摘要 这项建议的总体目标是提高女性的生活质量 老病人群体。最近的调查表明，女性患者 人口构成退伍军人保健用户增长最快的部分， 盆底疾病(大小便失禁、盆腔器官脱垂)有 在这一患者群体中极为常见。据报道大便失禁 大约有7%-10%的60岁以上的女性。与分娩有关的伤害/ 外括约肌损伤(EAS)是最常见的 大便失禁的原因。最常见的外科手术 用于治疗大便失禁的是重叠括约肌成形术和长 长期随访研究表明，这种手术矫正的成功率很低。我们 计划使用动物模型来研究EAS的长度拉伸特性， 然后进行一系列实验，以证明这种知识可以 用于增强肛管压力和排便功能。我们的预赛 资料显示，体内手术的EAS肌肉肌节长度多 小于其最佳长度，有可能通过以下方式获得EAS肌肉功能 增加EAS肌节长度。我们研究的具体目标是：1) 确定手术折叠术对EAS肌节的影响 在动物模型(兔)中的长度和体内肛管压力。我们会 还确定了EAS应用对增益耐久性的长期影响 EAS的肌肉功能。2)我们还将研究以下内容以了解原因 括约肌成形术并不能提供持久的效果。的目标 在我们的动物模型(兔)中进行的这些研究将确定：a) EAS肌切开术对大便失禁发展的影响B)的影响 肌切开术对肌节长度的影响c)括约肌成形术 不同程度的重叠对EAS肌肉功能的影响。3)长度张力 EAS肌肉在人体内的关系显示长度张力 兔子和人类的特性是相似的。

ABSTRACT The overall objective of this proposal is to improve the quality of life of female Veteran patient population. Recent surveys indicate that the female patient population constitutes the fastest growing segment of VA health care users and pelvic floor disorders (fecal and urinary incontinence, pelvic organ prolapse) are extremely common in this patient population. Fecal incontinence is reported approximately, 7-10% of women over the age of 60. Child birth related injury/ trauma to external anal sphincter injury (EAS) is attributed as the most common cause of fecal incontinence. The most commonly performed surgical procedure for the treatment of fecal incontinence is overlapping sphincteroplasty and long term follow up studies show a poor success rate with this surgical correction. We plan to use an animal model to study the length tension properties of the EAS, and then perform a series of experiments to show that this knowledge can be used to enhance anal canal pressure and continence function. Our preliminary data show that the in-vivo operational EAS muscle sarcomere length is much smaller than its optimal length and it is possible to gain EAS muscle function by increasing the EAS sarcomere length. The specific goals of our study are: 1) To determine the effects of surgical plication of the EAS on the EAS sarcomere length and the anal canal pressure in-vivo in an animal model (rabbit). We will also determine the long-term effects of EAS plication on the durability of gain in the EAS muscle function. 2) We will also study the following to understand why sphincteroplasty operation does not provide the long lasting effects. The goals of these studies in our animal model (rabbit) will be to determine: a) The effects of the EAS myotomy on the development of fecal incontinence. b) The effect of EAS myotomy on the sarcomere length c) The effects of sphincteroplasty with varying degrees of overlap on the EAS muscle function. 3) The length tension relationship of the EAS muscle in the humans to show that the length tension properties of the rabbit and humans are similar.