대한대장항문학회

Many kinds of different treatment options for fecal incontinence such as biofeedback<br>therapy, anterior or posterior sphincteroplasty, pelvic floor repair, gracilis or gluteus<br>muscle transposition have been introduced. However, appropriate indications for these<br>treatment options have not yet been delineated up to now.<br>Purpose : The aim of this study was to access the preoperative severity of fecal<br>incontinence by physiologic tests to give an idea that indications of appropriate selection<br>criteria and parameters for assess the outcome could be simultaneously considered by<br>preoperatively objective physiologic data.<br>Materials and Methods : From January 3, 1997 to, August 1, 1997 all patients with<br>fecal incontinence who visited colorectal clinic in the Department of Surgery, Korea<br>Veterans Hospital, were classified into two groups according to the severity of fecal<br>incontinence (0∼20): Group I (1 ∼9), Group II (10∼20) and compared them with the<br>results of physiologic tests: anorectal manometry, endorectal ultrasound (ERU),<br>cinedefecography, and pudendal nerve terminal motor latency (PNTML). Statistical<br>analysis was performed by Student's-t test, and Chi-square test and p<0.05 was<br>considered significant.<br>Results : The number of GI was 25, and GII was 22. There were no differences<br>between the two groups in terms of age (GI: 57.7±14.5, GII: 61.4±14.0years), gender<br>(male: female, 19:6, 16:6), cause (neurogenic; 11/25 (GI),7/22(GII), postanal surgery;<br>6/25,6/22) obstetric trauma (2/25, 2/22), anal trauma (1/25, 1/22) diabetes melitus (1/25,<br>2/22), rectal prolapse (2/25, 1/22), and others (2/25, 3/22), duration of fecal incontinence<br>(64.4±82.2, 48.7±65.3 months), high pressure zone (3.3±1.7, 3.5±1.4 cm), mean resting<br>pressure (50.5±27.0, 51.9±18.7 cm H<sub>2</sub>O), maximal resting pressure (88.4±<br>50.6, 89.4±41.8 cm), maximal squeezing pressure (150.6±71.0, 129.7±59.5 cm<br>H<sub>2</sub>O), rectoanal inhibitatory reflex (13/21, 8/21 positive), sensitivity (37.5±<br>15.2, 41.8±29.0 cc), compliance (19.0±14.5, 21.4±39.4 cc/cm H<sub>2</sub>O) in<br>anorectal manometric findings, anal sphincter defect (13/21, 15/22 positive), size of defect<br>(60±26.30°, 71 ±30.8°/360°), thickness of the external anal sphincter (3.46±0.78, 3.84<br>±1.02 cm), thickness of internal anal sphincter (1.58±0.79, 1.74±0.81 cm) in ERU,<br>anorectal angle in rest (85.2±28.0°, 97±22.9°), squeeze (72±27.1°, 82 ± 19.7°), push<br>(100±43.9°, 117.9±34.5°), length of perineal descent in rest (3.7±1.2, 3.6±1.7 cm),<br>squeeze (2.9±1.5, 2.7±1.5 cm), push (7.9±3.5, 6.6±2.6 cm) in cinedefecography.<br>However, rectal capacity in manometry (212.5±99.9, 155±51.5 cc, p<0.05), right PNTML<br>(1.73±0.39, 2.71±0.83 ms, p<0.001), and left PNTML (1.83±0.43, 2.94±0.80 ms, p<0.001)<br>were significantly increased in GII compare to those of GI.<br>Conclusion : As the severity of fecal incontinence was increased, rectal capacity, right<br>and, left PNTML were increased.<br>