Sacral neuromodulation for the prevention of a permanent stoma in patients with severe defecation disorder following intersphincteric resection
Sacral neuromodulation for the prevention of a permanent stoma in patients with severe defecation disorder following intersphincteric resection
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DOI：
10.1007/s00595-021-02233-5
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发表时间：
2021-02-16
期刊：
影响因子：
2.5
通讯作者：
Ito, Masaaki
中科院分区：
文献类型：
--
作者：
Enomoto, Hiroya;Nishizawa, Yuji;Ito, Masaaki
目的低位直肠癌结肠肛管吻合术中，严重排便障碍是常见的并发症，影响患者的生活质量。据报道，直肠切除术后骶神经调节（SNM）是成功的，但对采用括约肌间切除术（ISR）治疗的患者没有结果。方法采用回顾性单中心研究方法，对ISR术后排便障碍患者进行SNM治疗。对治疗前和治疗后的排便频率、大便失禁发作以及Wexner、LARS和FIQL评分进行评估，以评价疗效。良好反应定义为每日排便频率或每周大便失禁发作减少>= 50%。结果10例患者（7例男性，平均年龄67.5岁）接受SNM。所有患者均患有重度大便失禁，Wexner评分中位数为15（13-20），LARS评分中位数为41（36-41）。SNM后Wexner评分改善，但不显著（p = 0.06）。SNM后LARS和FIQL评分显著改善（p = 0.02，p = 0.01）。随访结束时，良好反应率为40%。3例反应不佳的病例需要建立永久性造口。结论10例患者中有7例在SNM后不需要永久性结肠造口。在进行永久性结肠造口术之前，应考虑SNM。
Purpose Severe defecation disorder occurs frequently in coloanal anastomosis for low rectal cancer, and may affect quality of life. Sacral neuromodulation (SNM) has been reported to be successful after rectal resection, but there are no results for patients treated with intersphincteric resection (ISR). Methods A retrospective single-center study of SNM was performed for patient with defecation disorder following ISR. Pre- and post-treatment bowel frequencies, fecal incontinence episodes, and Wexner, LARS and FIQL scores were assessed to evaluate the efficacy. A good response was defined as >= 50% reduction of bowel frequency per day or fecal incontinence episodes per week. Results 10 patients (7 males, mean age 67.5 years) underwent SNM. All patients had severe fecal incontinence with a median Wexner score of 15 (13-20) and a median LARS score of 41 (36-41). The Wexner score improved after SNM, but not significantly (p = 0.06). LARS and FIQL scores significantly improved after SNM (p = 0.02, p = 0.01). At the end of follow-up, the good response rate was 40%. Three cases without a good response required creation of a permanent stoma. Conclusion Seven out of 10 patients did not require a permanent colostomy after SNM. SNM should be considered before performing a permanent colostomy.