The evaluation of functional anorectum for impaired anal sphincters

近年来，许多改善肛门直肠畸形患者肛门直肠吻合的方法已被开发出来。严重的肛门直肠失禁常发生在高位型肛门闭锁伴骶部异常，导致肛门括约肌的神经支配缺陷。这些病例的肛门失禁被认为不仅是肛门括约肌的量的不足，而且是由于肛门括约肌的质的功能障碍。本文研究了骶神经失神经支配后肛门括约肌的电生理和组织化学变化，证明直肠肛门反射是内括约肌的依赖性反应，骶神经失神经支配使内括约肌处于无抑制状态，括约肌内的抑制神经元和促进神经元从中枢神经系统中游离出来，在组织化学检查中，我们证实了骶神经失神经支配引起了支配内括约肌的神经纤维中神经丝和突触囊泡表达的异常。我们建议，电生理和免疫组织化学研究可以作为寻找肛门直肠异常患者肛门直肠失禁复杂病理生理学线索的有效技术。这些研究可能为我们开发一种新的手术方法以改善腰椎间盘突出症提供线索。

In recent years numerous methods for improving anorectal continence in patints with anorectal anomalies have been developed. Severe anorectal incontinence frequently develops in high type anal atresia with sacral anomalies which lead to defective innervation of anal sphincter. The feacal incontinence of these cases is thought to be caused not only by the quantative insufficiency but also by the qualitative dysfunction of the anal sphincter muscles.We established the canine model of feacal incontinence by the sacral nerve denervation. We studied the electrophysiological and histochemical changes in the anal sphincter muscles caused by the sacral nerve denervation.In the electrophysiological examination, we proved that the rectoanal reflex was dependent reaction of the internal sphincter, and that the sacral nerve denervation caused the uninhibited state of innervation in the internal sphincter that the inhibitory neuron and accelance neuron in the sphincter muscles were freed from the central inhibition.In the histochemical examination we proved that the sacral nerve denervation caused abnormalities of both neurofilament and synaptic vesicle expression in the nerve fivers which innervated the internal sphincter muscle.We propose that the electrophysiological and immunohistochemical studies could be available techniques to seek clue the complex pathophisiology of anorectal incontinence in patients with anorectal anomalies, and these studies may give us a hint to develop a new operative procedure for improving continence.