盆底肌训练治疗小儿肌原性大便失禁的临床评价

目的 评价盆底肌训练治疗小儿肌原性大便失禁的临床效果.方法 2002～2005年间选择两院大便失禁患儿28例,男19例,女9例,年龄4～12岁,其中肛门闭锁术后23例,先天性巨结肠术后5例,临床评分在3～4分之间.肛门直肠测压结果表明全部病例直肠感觉正常,肛管静息压和收缩压低,收缩压在80 mm Hg以上.应用生物反馈仪行肛门括约肌及盆底肌训练2周,1次/d,30 min/次,2周后嘱患儿在家中进行盆底肌肉收缩训练,1年后随访.所有患儿训练前、训练2周后及训练后1年行肛门测压,并进行临床评分.结果 5例患儿不能配合而放弃治疗.其余23例训练2周后肛门收缩压、持续收缩时间和肛门功能临床评分均明显提高,而肛管静息压无变化.1年后14例(A组)能坚持训练的患儿,肛门功能进一步提高,肛管静息压也较前增加,9例(B组)未能坚持训练回复到训练前的水平.结论 盆底肌训练对小儿大便失禁有良好的疗效.盆底肌肉的训练应该长期坚持,才能保持疗效.     

先天性巨结肠Soave术后大便失禁的评价和治疗

目的 对先天性巨结肠Soave术后大便失禁进行评价和治疗.方法 先天性巨结肠Soave术后大便失禁患儿24例,男14例,女10例,年龄6～13岁,肛门功能临床评价为良19例,差5例.全部患儿行肛门直肠测压,并与18例肛门功能正常的Soave术后儿童比较.所有患儿在医院接受生物反馈训练2周后自行在家中行盆底肌收缩训练.结果 肛管静息压、收缩压、直肠初感觉分别为(18.9±6.2)mmHg、(179.9±17.8)mmHg、(45.4±9.4)ml,与18例对照组儿童相比[分别为(44.5±11.1)mmHg、(177.7±15.9)mmHg、(50.0±10.1)ml],静息压明显下降,收缩压、直肠感觉无明显变化.3例不配合治疗,21例1年后除5例未能坚持外,其余16例获得良好的肛门控制,肛管静息压、肛管收缩压、直肠初感觉分别为(35.4±8.7)mmHg、(195.3±15.0)mmHg、(45.9±8.4)ml.肛管静息压和收缩压均升高.结论 内括约肌损伤可能是先天性巨结肠Soave术后大便失禁的原因之一,对此盆底肌训练可取得满意的治疗效果.

Abstract：

Objective To evaluate the efficacy of pelvic floor muscle exercise for the treatment of fecal incontinence after Soave procedure for Hirschsprung's disease. Methods Twenty four patients who had Soave procedure for Hirschsprung's disease and presented fecal incontinence after surgery were recruited in this study. They were 14 males and 10 females, aged from 6 to 13 years old. Eighteen children who had normal defecation after Soave procedure were selected as controls. All the subjects had manometry to measure resting anal canal pressure, squeeze pressure, and rectal sensation.All the patients had two weeks biofeedback therapy during their stay in hospital. After being discharged, they were taught and prescribed to do pelvic floor muscle exercise at home. Results Of the children with fecal incontinence, the resting anal canal pressure, squeeze pressure and rectal sensation were ( 18. 9 ± 6. 2 ) mmHg, ( 179. 9 ± 17. 8) mmHg, (45. 4 ± 9. 4) ml, respectively. Compared with the controls, the resting anal canal pressure was lower [(18. 9±6. 2) mmHg vs (44. 5 ± 11.1) mmHg].But no difference of squeeze pressure and rectal sensation was found between the 2 groups [(179. 9 ±17. 8)mmHg vs (177. 7 ± 15. 9) mmHg, (45.4 ± 9. 4)ml vs (50. 0 ± 10. 1)ml]. Three patients dropped out of the therapy. Five patients stopped the exercise after the first year. The other 21 who kept exercise improved their defecation function. Their resting anal canal pressure, squeeze pressure and rectal sensation were (35. 4 ± 8. 7)mmHg, (195. 3 ± 15.0)mmHg and (45. 9 ± 8. 4)ml, respectively. Conclusions The dysfunction of internal anal sphincter might be the main cause for fecal incontinence after Soave procedure. Pelvic floor muscle training is helpful to improve the defecation function of the patients.     

Gluteus maximus flap transplantation for anrectal dysfunction after anorectal malformation operation

目的 评价臀大肌瓣转移肛提肌加强术治疗肛门直肠畸形术后排便功能障碍的恢复情况.方法 选择28例先天性肛门闭锁术后排便功能障碍的患儿,年龄4～14岁,男19例,女9例,单纯肛提肌功能不良的18例,肛提肌和肛门外括约肌功能均不良的10例,全部行臀大肌瓣转移肛提肌加强术,术前均行盆底肌MRI、钡灌肠及臀大肌肌电图检查,手术前后均行结肠传输试验、肛门直肠测压和排便功能评分.术后对患儿进行6～48个月的随访,平均24个月.结果 28例手术患儿中26例获得随访,术前臀大肌肌电图均显示臀大肌功能良好,钡灌肠显示直肠无扩张,结肠传输试验表现为出口梗阻,盆底肌MRI见28例患儿肛提肌发育薄弱或不对称,排便功能评分结果示28例患儿均差.肛管静息压手术前后分别为(16.77±4.25) mmHg和(18.67±4.48)mmHg、肛管最大收缩压在手术前后分别为(61.05±14.37) mmHg和(72.12±16.76)mmHg,差异均无统计学意义(P＞0.05),术后单纯肛提肌功能不良的排便功能评分达优6例,良10例,肛提肌和肛门外括约肌功能均不良的排便功能评分优0例,良2例,差8例.优良率占69.23％.结论 对于肛提肌功能不全所导致的排便功能障碍,行臀大肌瓣转移肛提肌加强术可改善排便功能,部分括约肌功能不良的患儿术后可能失禁不能改善或者加重,需要进一步的手术或训练治疗.     

生物反馈治疗先天性巨结肠患儿术后大便失禁的疗效分析

目的评估生物反馈治疗先天性巨结肠患儿术后大便失禁的有效性。方法回顾性分析50例先天性巨结肠术后大便失禁患儿的临床资料, 其中男42例, 女8例;患儿平均年龄为8.1岁, 年龄范围在3.7～14.0岁;50例患儿均行先天性巨结肠改良Soave术。采用直肠肛管测压及Kelly’’s临床评分评价大便失禁的程度, 评分为1～2分为重度组(39例), 评分为3～4分为轻度组(11例);利用生物反馈治疗仪对患儿进行治疗, 7～10 d为1个疗程, 休息1周后进行下一疗程, 同时指导患儿主动进行盆底肌收缩训练, 3个疗程为一阶段进行全面评估。采用单组数据重复测量方差分析两组患儿生物反馈治疗前后肛管最大收缩压、肛管最长收缩时间、肛管静息压和直肠静息压指标。结果 50例均获得随访, 随访时间为6个月至4年。轻度组治疗前肛管静息压为(39.71±22.19)mmHg, 治疗6个疗程后肛管静息压为(61.88±28.53)mmHg, P<0.05;重度组治疗前肛管静息压为(34.62±26.66)mmHg, 治疗6个疗程后肛管静息压为(59.03±24.06)mmHg, P<0.05。轻度组治疗...     

改良股薄肌转移代外括约肌行肛门重建治疗肛门闭锁术后大便失禁

目的 评估改良股薄肌转移代肛门外括约肌重建术治疗肛门闭锁术后大便失禁的临床效果.方法 回顾性分析自2003年8月至2012年8月于山东大学第二医院小儿外科收治的31名行改良股薄肌代肛门外括约肌治疗大便失禁患儿的病例资料,围绕术前及术后大便临床表现进行病历分析.并依据术前倒立位腹部平片显示的闭锁程度将入选病例分为三组.所有入选病例的手术前、后临床表现均采用克利夫兰大便失禁程度评分系统进行评分并分级.按照其资料的分布及性质,手术前后的比较依据正态性分布情况选用配对t检验或者非参数检验,组间的比较采用依据正态性分布情况和方差齐性选用成组设计方差分析,两两比较采用LSD方法.结果 入选病例术后随访6～87个月,平均33.9个月,22例患儿获得大便排放的自主性控制,大便失禁评分明显降低,与术前相比差异具有统计学意义;肛门直肠测压结果显示肛管最大收缩压及肛管静息压明显增加,手术前后差异具有统计学差异;直肠静息压手术前后未见明显变化,差异无明显统计学意义.结论 改良股薄肌转移代肛门外扩约肌通过提高肛管收缩压及肛管静息压以维持肛管的严密闭合达到大便排放的自主控制,是治疗肛门闭锁术后大便失禁的有效方法.     

反射诱导训练与小儿大便失禁的康复

为了提高小儿先天性肛门直肠畸形术后或其他外伤所致大便失禁的治疗效果，对１８例２～１５岁进行过括约肌重建术的患儿，行加强盆底肌的协同共济肌与毗邻肌肌力的诱导训练和反射诱导恢复排便控制反射的康复治疗。随访１～９年，结果能坚持康复训练组７例，均于半年内达到社会可接受的排便控制，而不能配合训练组１１例中，仅４例在１年内恢复排便控制。反射诱导训练比生物反馈训练更经济、更易学，适合我国国情，可缩短康复时间，提高患儿日后的生活质量。     

经肛门直肠黏膜及内括约肌切除术治疗先天性巨结肠的技术要点和疗效

目的 探讨肛门内括约肌大部切除对治疗小儿先天性巨结肠的技术可行性和临床效果.方法 从2001年7月至2006年12月,对127例先天性巨结肠患儿根治术中进行内括约肌大部切除,手术时患儿年龄8 d～16岁,平均年龄0.96岁,小于3个月的33例,其中新生儿12例.术前43例(33.8%)有肠炎病史,手术方法:在齿线水平的直肠黏膜与肛管皮肤的交界处环周切开黏膜及肛门内括约肌;沿内、外括约肌之间隙向盆腔侧分离1cm后;在前壁切开直肠的肌层至黏膜下层,沿着黏膜下层向上分离直达腹膜返折水平切开肌鞘,入腹腔;在后壁沿着直肠纵肌,一直向上分离至相应的腹膜返折水平.将正常结肠拖出至肛缘水平与肛管黏膜皮肤相吻合.结果 本组127例患儿均经肛门行内括约肌和直肠后壁肌鞘切除术,目前106例患儿术后已随访1至7年,术后仅2例患儿有肠炎病史,术后肠炎发生率为1.8%,比术前明显减少(P<0.01).3例(2.7%)患儿手术后便秘,1例在外院确诊为结肠神经元发育不良症,行结肠切除手术后治愈.手术后1个月时污便的发生率37.6%,随手术后时间的延长,手术后6个月时污便下降至1.8%.肛门直肠测压结果显示:对照组肛管静息压力为(27.9±9.6)mm Hg;先天性巨结肠患儿手术前的肛管静息压力为(37.9±12.5)mm Hg,比对照组明显增高(P<0.05);手术后1、2、3、6个月肛管静息压力分别为(20.2±6.4)、(21.4±8.8)、(22.8±10.4)、(24.8±9.9)mm Hg,手术后肛管静息压力比手术前明显减低(P<0.01),术后6个月内患儿的肛管静息压力有上升的趋势,与对照组差异无统计学意义.结论 本研究结果表明经肛门内括约肌大部切除安全易行,可有效地预防小儿先天性巨结肠术后肠炎和便秘的发生.     

经皮神经电刺激治疗脊髓栓系综合征术后排便功能障碍

目的 评价经皮神经电刺激对脊髓栓系综合征(TCS)术后患儿排便功能障碍的治疗效果.方法 随访TCS术后存在排便功能障碍患儿15例.男8例,女7例;年龄8.8(5～18)岁,平均手术年龄6岁(1个月～10岁),平均随访时间8.2(2～16)a.均接受经皮骶神经电刺激治疗,并于治疗前后分别行肛门功能评定,肛门括约肌神经电生理和直肠肛管测压客观检测,对治疗效果进行综合评定.采用Excel 5.0进行配对t检验.结果 治疗后TCS患儿的排便功能障碍症状较治疗前明显缓解,肛门功能临床评分[(3.27±1.44)分vs (4.95±0.73)分]、肛管收缩压[(113.99±59.98)mmHg (1mmHg=0.133 kPa) vs (169.27±41.25)mmHg]、肛管收缩向量容积[(46 174.95±929.37)cm×mmHg2 vs (69021.25±785.65)cm×mmHg2]较治疗前均显著增高(t=2.57, 2.62, 2.32 Pа<0.05),会阴-肛门反射潜伏期[(84.98±13.82) ms vs (52.02±10.81)ms]、脊髓-肛门反应潜伏期[(6.73±1.32)ms vs (4.62±0.99)ms]均较治疗前明显缩短(t=3.13,2.40.Pа<0.05).结论 经皮神经电刺激治疗TCS术后患儿排便功能障碍疗效显著、操作简单,对改善排便功能障碍、提高患儿生活质量具有重要意义.     

股薄肌转移代肛门外括约肌重建术治疗大便失禁

目的总结神经压榨股薄肌转移代肛门外括约肌重建术治疗小儿大便失禁的指导原理、手术方法、操作经验、疗效以及并发症。方法回顾性分析1999年6月～2003年6月收治的71例大便失禁患儿病例资料,7l例均实施该手术。结果71例病例中59例行一次括约肌重建术成功,9例术后肛周感染,行清创术后成功,3例术后移植肌肉坏死,行二次括约肌重建术成功,术后临床主观评分以及直肠肛门测压均有明显的改观。结论神经压榨股薄肌转移代肛门外括约肌重建术治疗大便失禁是一种较为有效的方法。     

新生儿期一期肛门成形术治疗中位肛门直肠畸形疗效评价CSCD

目的总结中位肛门直肠畸形患儿行新生儿期一期肛门成形术与分期肛门成形术的远期排便功能及肛门直肠测压结果,评估新生儿期一期肛门成形术治疗中位肛门直肠畸形的临床疗效。方法回顾性收集2006年1月至2019年8月上海交通大学医学院附属新华医院小儿外科收治的132例中位肛门直肠畸形患儿临床资料,手术方式均为改良后矢状入路肛门成形术(mini-Peña),按照手术时期分为两组,A组为新生儿期接受一期肛门成形术的患儿,共22例;B组为接受传统三期肛门成形术的患儿,共110例。两组最远随访至术后15年。评估两组临床情况以及远期排便功能、并发症情况。术后排便功能评估采用Rintala评分,结果分为优、良、中、差四个等级。肛门直肠测压包括肛门静息压、肛门长度、内括约肌静息压及长度、外括约肌静息压及长度、直肠肛门抑制反射(rectoanal inhibitory reflex,RAIR)等。结果两组患儿性别比例、出生体重差异均无统计学意义(P>0.05)。单次肛门成形术后住院时间比较,A组长于B组[(17.1±3.9)d比(10.4±3.4)d,P<0.05];总住院时间及总手术时间比较,A组均明显短于B组,分别为(19.6±5.5)d比(37.5±10.7)d、(128.9±29.0)min比(287.9±61.2)min,差异均有统计学意义(P<0.05)。两组肛门长度以及内、外括约肌长度差异均无统计学意义(P>0.05);A组肛门静息压、内括约肌静息压及外括约肌静息压均高于B组,分别为(53.8±15.5)mmHg比(36.7±10.4)mmHg、(53.5±15.1)mmHg比(34.6±8.7)mmHg、(45.7±16.9)mmHg比(33.9±11.8)mmHg,差异均有统计学意义(P<0.05)。A组肛门直肠抑制反射引出率明显高于B组(66.7%比0%,P<0.05),其他肛门直肠测压数据差异无统计学意义(P>0.05)。两组Rintala评分优良率差异无统计学意义(83.3%比88.0%,P>0.05)。两组术后便秘、污粪的发生率以及术后并发症的发生率比较,差异均无统计学意义(P>0.05),分别为25.0%比28.0%、16.7%比16.0%、33.3%比50.7%。结论中位肛门直肠畸形行新生儿期一期肛门成形术可以获得良好的肛门控便能力。早期一期肛门成形术可避免造瘘以及造瘘关闭手术的创伤。     

电刺激生物反馈治疗先天性巨结肠术后大便失禁的疗效分析

目的探讨电刺激生物反馈治疗先天性巨结肠改良Soave术后大便失禁的近期和远期疗效。方法采用加拿大产Laborie生物电反馈刺激仪,对37例先天性巨结肠改良Soave术后大便失禁的患儿进行盆底肌电刺激、生物反馈治疗。37例中,普通型31例,长段型5例,全结肠型无神经节细胞症1例。新生儿期手术2例,3~6个月手术23例,6个月至1岁手术6例,1岁以后手术6例。所有患儿在医院接受10次以上生物反馈治疗,每周2次,并每天在家进行盆底肌收缩训练。结果 37例均获随访,随访时间1~4年,37例中,经10次生物反馈治疗后,症状完全消失34例(91.89%),其中有8例(21.62%)半年后又出现污粪现象,再次予10次生物反馈治疗后,症状完全消失;3例(8.11%)仍有污粪现象,其中2例为新生儿期手术后一直污粪的患儿,经3个疗程生物反馈治疗后明显好转,在腹泻时仍会出现污粪现象。结论内括约肌损伤可能是先天性巨结肠改良Soave术后大便污粪的原因之一,电刺激生物反馈疗法是一种可靠、无创、有效的治疗方法。     

Electrical stimulation and biofeedback exercise of pelvic floor muscle for children with faecal incontinence after surgery for anorectal malformation

We report our experience of electrical stimulation and biofeedback exercise of pelvic floor muscle for children with faecal incontinence after surgery for anorectal malformation (ARM). Electrical stimulation and biofeedback exercise of pelvic floor muscle were performed on children with post-operative faecal soiling following repair of intermediate or high type ARM. Children under the age of 5 years or with learning difficulties were excluded. They had 6 months supervised programme in the Department of Physiotherapy followed by 6 months home based programme. Bowel management including toilet training, dietary advice, medications and enemas were started before the pelvic floor muscle exercise and continued throughout the programme. Soiling frequency rank, Rintala continence score, sphincter muscle electromyography (EMG) and anorectal manometry were assessed before and after the programme. Wilcoxon signed rank test was performed for statistical analysis. From March 2001 to May 2006, 17 children were referred to the programme. Twelve patients (M:F = 10:2; age = 5–17 years) completed the programme. There was a trend of improvement in Rintala score at sixth month (p = 0.206) and at the end of programme (p = 0.061). Faecal soiling was significantly improved at sixth month (p = 0.01) and at the end of the programme (p = 0.004). Mean sphincter muscle EMG before treatment was 1.699 μV. Mean EMG at sixth month and after the programme was 3.308 μV (p = 0.034) and 3.309 μV (p = 0.002) respectively. After the programme, there was a mean increase in anal sphincter squeeze pressure of 29.9 mmHg (p = 0.007). Electrical stimulation and biofeedback exercise of pelvic floor muscle is an effective adjunct for the treatment of faecal incontinence in children following surgery for anorectal malformation.     

小儿神经原性膀胱手术前后尿流动力学检查评价

目的　基于手术前后尿流动力学检查结果的分析,对小儿神经原性膀胱逼尿肌和括约肌不协调的成因进行讨论,并对外科治疗进行评价。方法　55例行盆底肌加强及膀胱颈悬吊的神经原性膀胱患儿于术前和术后4～10个月行尿流动力学对照检查,然后分析其结果并行统计学处理。结果　34例逼尿肌反射亢进型中,30例术后逼尿肌和括约肌不协调减轻或较协调,4例无变化。最大膀胱容量增加（89.0±17.2）ml,最大尿道压力下降（2.7±0.37）kPa,最大尿道闭合压下降（3.1±0.6）kPa;21例术后逼尿肌无反射或反射低下型,逼尿肌反射明显改善11例,改善10例,最大膀胱容量增加（55.6±10.3）ml,最大尿道压力增加（2.9±0.7）kPa,最大尿道闭合压增加（2.6±0.7）kPa。结论　盆底肌加强和膀胱颈悬吊手术是治疗小儿神经原性膀胱的良好术式。因腰骶部脊膜膨出所致的小儿神经原性膀胱逼尿肌与外括约肌协同失调本质上可能是尿道外括约肌对漏斗状膀胱颈代偿性收缩的一个表现。     

肛管直肠角形成和维持的解剖机制及其临床应用

目的 通过对肛管周围解剖关系的观察,分析肛管直肠角形成和维持的解剖机制,为临床提供形态学参考依据。方法 从盆部侧方对５９例小儿肛直肠周围相关结构进行了层次解剖观察和测量。结果 会阴体是由会阴深、浅横肌、球海绵体肌、前列腺提肌（或耻骨阴道肌）和肛门外括约肌前部纤维交绢面成的腱质结构,肛管前壁上部的直肠纵肌和肛门内括约肌也向前呈角状突起,融合于会阴体。耻骨直肠肌与前列腺提肌（或耻骨阴道骨）共同起于耻骨     

Internal sphincter-saving posterior sagittal anorectoplasty for high and intermediate anorectal malformations — technical considerations

Posterior sagittal anorectoplasty (PSARP) has gained overall acceptance as a standard surgical approach for the repair of high and intermediate anorectal malformations. PSARP allows superior exposure for the identification of the spectrum of these defects and enables anatomic reconstruction of the anal canal and voluntary sphincter muscle complex. In the original PSARP procedure, the involuntary internal anal sphincter, which in embryologic and clinical studies has been shown to be present in the region of the fistulous bowel termination, is not preserved. Internal sphincter-saving PSARP was performed in 65 patients with high or intermediate anorectal malformations. Manometrically, a positive rectoanal inhibitory reflex was noted in 82% of the patients, suggesting the presence of a functional internal sphincter. There was a statistically significant difference in the anorectal resting pressures between patients with a functional internal sphincter and patients without this structure. The technical details of internal sphincter-saving PSARP are described and illustrated in the present communication.     

Postoperative internal sphincter function in anorectal malformations — a manometric study

An anorectal manometric assessment of 30 patients with operated high or intermediate anorectal malformations was performed in order to study internal sphincter function in the reconstructed anal canal. In 14 patients (group I, mean age 3.1 years) the rectal blind pouch and fistula, when present, were used in the reconstruction of the anal canal by posterior sagittal anorectoplasty (12 cases) or sacroperineal pull-through (2 cases). In 16 cases (group II, mean age 8.8 years) the anal canal was reconstructed from proximal rectum or sigmoid by sacroabdominoperineal pull-through. In 11 of the 14 patients in group I manometric findings suggested the presence of a functioning internal sphincter. The pattern of anal slow-wave activity and rectoanal inhibitory reflex was normal. None of the patients in group II had a rectoanal inhibitory reflex and the slow-wave activity was of a colonic type. The resting anorectal pressure profiles were significantly higher in group I than in group II (mean 38 cm H₂O vs. 25 cm H₂O). The fecal continence of patients in group I was superior to those in group II despite their much younger ages. The findings of this study indicate that in anorectal malformations there is internal sphincter function in the distal rectal blind pouch and that it can and should be preserved when the anal canal is reconstructed.     

脊髓拴系松解术后脊柱裂患者的肛管直肠功能研究

目的：与临床对于脊柱裂致膀胱功能障碍的大量研究报道相比,关于脊柱裂患者的肠道功能障碍研究资料非常有限。该文拟研究脊柱裂患者行脊髓拴系松解术后的肛管直肠功能。方法：采用多通道肛管直肠测压技术对因排尿功能障碍而来就诊的21例脊柱裂患者进行肛管直肠功能检测,入选患者皆已于至少2年前行脊髓拴系松解术。结果：脊柱裂患者的最大肛管静息压低于对照组,但二者没有统计学差异(P=0.372)。在嘱脊柱裂患者行最大限度收缩肛门动作时,绝大多数患者肛管压力没有任何升高。在行模拟排便动作时,19例(90.5%)患者表现为盆底功能紊乱型肛管压力变化。直肠肛管抑制反射在所有受检者均存在,诱发该反射所需最小直肠气囊容量在脊柱裂患者组和对照组间差异无显著性(P=0.725);诱发持续性直肠肛管抑制反射所需直肠气囊容量在脊柱裂患者组显著性高于对照组(P<0.001)。直肠感觉阈值在脊柱裂患者显著高于对照组(P<0.0001)。结论：大多数脊柱裂患者不能自主收缩肛门外括约肌,排便时表现为盆底功能紊乱型直肠肛管压力曲线,同时直肠感觉功能也受到严重损害。直肠肛管抑制反射在所有脊柱裂患者均存在,该反射可能受到中枢神经系统的调控。     

A computerized vector manometry and MRI study in children following posterior sagittal anorectoplasty

The study was designed to evaluate computerized eight-channel vector manometry (8CVM) and pelvic floor magnetic resonance imaging (MRI) as methods to assess the anal sphincter following posterior sagittal anorectoplasty (PSARP) for anorectal malformations, in particular the functional capacity of the sphincter structures in correlation with postoperative MRI findings. Seventeen children had been operated upon for a rectovesical, -urethral, or -vaginal fistula including one female cloacal malformation; 4 had a secondary PSARP. Mean follow-up was 5.57 years. Continence was evaluated with a modified Kelly score. A CVM technique with an eight-channel perfusion catheter was used. In addition to software-supported data, the manometric parameters included a score-system assessing three different pressure zones of the anal canal qualitatively on the three-dimensional image of the anal sphincter profile. The same procedure was performed on sagittal, oblique axial, and oblique coronal MRI. Furthermore, the thickness of the sphincter muscle was assessed at the level of the maximal mean segmental pressure. All children had decreased absolute vector-volumetry values at rest and on squeezing. Correlation with the clinical score was poor. Correlation of the manometric score with the clinical course was similar to the correlation of MRI score with clinical course (R = 0.425; P = 0.1). Thirteen children demonstrated normal or increased sphincter length; 5 of these had a decreased high-pressure zone (HPZ). The position of the anorectum in the sphincter muscles could be evaluated by the vector-volumetry image as anatomic in 11 cases, nearly correctly positioned in 4, and ectopic in 1 child. MRI detected 2 cases of malposition, 10 anatomic, and 4 nearly-anatomic findings. Correlation of the manometric score with the MRI score and the thickness of the sphincter muscle at the HPZ was significantly high (R = 0.801; P < 0.0001). 8CVM is thus highly sufficient in illustrating the function of the sphincter musculature seen on pelvic floor MRI. Both methods only moderately reflect clinical follow-up, since continence depends on more than sphincter ability. Accepted: 9 March 2000