Six Years of Experience With Sacral Nerve Stimulation for Fecal Incontinence
Six Years of Experience With Sacral Nerve Stimulation for Fecal Incontinence
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DOI：
10.1007/dcr.0b013e3181ca7dc2
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发表时间：
2010-04-01
影响因子：
3.9
通讯作者：
Buntzen, Steen
中科院分区：
文献类型：
--
作者：
Michelsen, Hanne B.;Thompson-Fawcett, Mark;Buntzen, Steen
目的：骶神经刺激是许多治疗大便失禁的新手术方式之一。骶神经刺激的短期效果比其他方式更令人鼓舞。本研究的目的是报告经皮神经评估测试和骶神经刺激治疗大便失禁的结果，从一个中心开始，覆盖了6年的时间。方法：所有在2001年3月至2007年3月期间在我们肛门生理科接受经皮神经评估测试和骶神经刺激的候选人都被纳入研究。结果：共有177例大便失禁患者（160例女性）接受了经皮神经评估试验，中位年龄59.5岁（范围27-88岁）。在这些患者中，142例（80%）检测呈阳性，其中25例（84%）患者中有21例需要重复经皮神经评估测试。由于功能衰竭，16例患者接受了永久电极的翻修，其中7例（44%）对翻修后的功能结果满意。126例患者中，15例（12%）接受了移植，感染率仅为1.6%。总体而言，中位随访24个月（范围3-72）后，中位Wexner失禁评分从16分（范围6-20）降至10分（范围0 -20）（P < 0.0001）。在接受至少6年治疗的10例患者中，效果持续，中位Wexner失禁评分从20（范围12-20）降至7（范围2-11）（P < 0.0001）。结论：骶神经刺激是一种简单、安全、微创的技术，发病率低，效果好，术后6年内均可保持。对于接受治疗的患者，中位Wexner失禁评分在中位随访24个月（范围3-72个月）后显著下降。12%被移植。感染率为1.6%。
PURPOSE: Sacral nerve stimulation is one of many new surgical modalities for fecal incontinence. Short-term results from sacral nerve stimulation have been more encouraging than those from other modalities. The aim of this study was to report the outcome of percutaneous nerve evaluation tests and sacral nerve stimulation for the treatment of fecal incontinence from a single center covering a period of 6 years since the procedure was introduced.METHODS: All of the candidates for a percutaneous nerve evaluation test and sacral nerve stimulation seen at our anal physiology unit between March 2001 and March 2007 were included in the study.RESULTS: A total of 177 patients with fecal incontinence (160 females), median age 59.5 (range, 27-88) years, underwent a percutaneous nerve evaluation test. Of these patients, 142 (80%) had a positive test, including 21 of 25 (84%) patients who required a repeat percutaneous nerve evaluation test. Because of a functional failure, 16 patients underwent a revision of the permanent electrode, 7 of whom (44%) were satisfied with the functional result after the revision. Of 126 patients, 15 (12%) have undergone an explantation, with an infection rate of only 1.6%. Overall, after a median follow-up of 24 (range, 3-72) months, the median Wexner incontinence score decreased from 16 (range, 6-20) to 10 (range, 0 20) (P < .0001). In the 10 patients who underwent at least 6 years of treatment, the effect was sustained, as the median Wexner incontinence score decreased from 20 (range, 12-20) to 7 (range, 2-11) (P < .0001).CONCLUSION: Sacral nerve stimulation is a simple, safe, and minimally invasive technique with low morbidity and excellent results, which appear to be maintained for the first 6 years after the procedure. For patients who underwent the treatment, median Wexner incontinence score decreased significantly after a median follow-up of 24 (range, 3-72) months. Twelve percent were explanted. The infection rate was 1.6%.