Efficacy of Sacral Nerve Stimulation for Fecal Incontinence in Patients with Anal Sphincter Defects
Efficacy of Sacral Nerve Stimulation for Fecal Incontinence in Patients with Anal Sphincter Defects
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DOI：
10.1007/dcr.0b013e31819f7400
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发表时间：
2009-07-01
影响因子：
3.9
通讯作者：
Gill, Kathryn A.
中科院分区：
文献类型：
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作者：
Boyle, Derek J.;Knowles, Charles H.;Gill, Kathryn A.
目的：骶神经刺激传统上用于治疗肛门括约肌完整的大便失禁患者。这一理论基础受到了挑战，但其疗效是否与括约肌损伤的程度有关尚不清楚。方法：这是一项前瞻性研究，15例括约肌缺损患者（9例合并，2例单纯外括约肌，4例单纯内括约肌）接受骶神经刺激治疗大便失禁。使用由两名独立观察员发布的系统回顾了肛管超声扫描并对缺陷进行了评分（0-16）。这些与以下结果相关：1)减少大便失禁发作，2)减少大便，3)改善克利夫兰诊所评分，4)改善推迟排便的能力。所有患者在暂时刺激后和永久植入后3至6个月再次进行研究。结果：13例患者（87%）进展为永久性刺激。平均每两周大便失禁次数从15次（范围1-53次）减少到3次（范围0-16次；P = 0.01）。中位脏污事件从10次（范围1-14次）减少到6次（范围0-14次；P = 0.009）。Cleveland Clinic评分中位数从12（范围9-18）降至9（范围4-14；P = 0.0005）。延迟排便能力显著提高（P = 0.05）。骶神经刺激后的括约肌缺损评分与预后无相关性(r(2) = 0.001-0.10；P = 0.28-0.94)。结论：骶神经刺激是治疗肛门括约肌缺损大便失禁的有效方法，其预后与肛门括约肌损伤的严重程度无关。
PURPOSE: Sacral nerve stimulation has traditionally been used to treat patients with fecal incontinence with intact anal sphincters. This rationale has been challenged, but it remains unknown if its efficacy is related to the extent of the sphincter injury.METHODS: This was a prospective study of 15 patients with sphincter defects (9 combined, 2 external only, and 4 internal only) undergoing sacral nerve stimulation for fecal incontinence. Endoanal ultrasound scans were reviewed and defects scored (0-16) with use of a system published by two independent observers. These were correlated with the following outcomes: 1) reduction in fecal incontinence episodes, 2) reduction in soiling, 3) improvement in Cleveland Clinic scores, and 4) improvement in ability to defer defecation. All patients were studied after temporary stimulation and again at three to six months after permanent implantation.RESULTS: Thirteen patients (87%) progressed to permanent stimulation. Median fecal incontinence episodes per two weeks decreased from 15 (range, 1-53) to 3 (range, 0-16; P = 0.01). Median soiling episodes were reduced from 10 (range, 1-14) to 6 (range, 0-14; P = 0.009). Median Cleveland Clinic scores decreased from 12 (range, 9-18) to 9 (range, 4-14; P = 0.0005). The ability to defer defecation was improved significantly (P = 0.05). There were no relationships between sphincter defect scores and outcome measures after sacral nerve stimulation (r(2) = 0.001-0.10; P = 0.28-0.94).CONCLUSION: Sacral nerve stimulation is an effective treatment in patients with fecal incontinence who have anal sphincter defects, and outcome is not associated with severity of sphincter disruption.