Redo sphincteroplasty: are the results sustainable?
Redo sphincteroplasty: are the results sustainable?
复制标题
重做括约肌成形术：结果是否可持续？
DOI：
10.1093/gastro/gov025
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发表时间：
2016-02
影响因子：
3.6
通讯作者：
Wexner SD
中科院分区：
文献类型：
--
作者：
Hong K;Dasilva G;Dollerschell JT;Maron D;Wexner SD
目的：本研究旨在调查接受重做括约肌成形术（RS）的患者的长期结果。方法：从前瞻性数据库中回顾性筛选 1988 年 11 月至 2011 年 12 月期间接受 RS 的大便失禁 (FI) 患者。问卷和电话调查评估了当前克利夫兰诊所大便失禁评分（CCFFIS；最佳 0，最差 20）和大便失禁生活质量（FIQoL；最佳 4.1，最差 1）量表。成功的定义是没有进一步的节制手术、没有造口并且完成随访时 CCFFIS <9。 Wilcoxon 和 Mann-Whitney U 检验用于比较定量变量。进行双变量逻辑回归分析以确定成功的预测因素。结果：84 名接受 RS 的患者中有 56 名 (66.7%) 在中位随访 74 个月（范围：12-283）个月后可进行评估。末次随访时平均CCFFIS从16.5±3.7下降至11.9±6.6（P<0.001）。 12 名患者（21.4%）因括约肌成形术失败而接受了进一步的节制手术，其中 3 名患者（5.4%）有永久性造口。 18 名患者 (32.1%) 完成随访时 CCFFIS <9，16 名患者 (28.6%) 取得了长期成功。 24 名接受 FIQoL 评估的患者的平均值为 2.6（范围：1.0-4.1）。术后CCFFIS与FIQoL相关（Spearman相关系数 = −0.854，P < 0.001）。逻辑回归分析没有揭示 RS 成功的任何显着预测变量。结论：根据我们的成功标准，中位 74 个月的 RS 长期成功率很低。
Objective: This study aimed to investigate the long-term outcomes of patients who undergo redo sphincteroplasty (RS). Methods: Patients with fecal incontinence (FI) who underwent RS between November 1988 and December 2011 were retrospectively identified from a prospective database. A questionnaire and telephone survey assessed current Cleveland Clinic Fecal Incontinence Score (CCFFIS; best 0, worst 20) and Fecal Incontinence Quality of Life (FIQoL; best 4.1, worst 1) scale. Success was defined as no further continence surgery, no stoma and CCFFIS <9 at completion of follow-up. The Wilcoxon and Mann-Whitney U tests were used for comparing quantitative variables. Bivariate logistic regression analysis was done to identify predictive factors for success. Results: Fifty-six (66.7%) of 84 patients who underwent RS were available for evaluation at a median follow-up of 74 (range: 12–283) months. The mean CCFFIS decreased from 16.5 ± 3.7 to 11.9 ± 6.6 (P < 0.001) at last follow-up. Twelve patients (21.4%) underwent further continence surgery for failed sphincteroplasty, three (5.4%) of whom had a permanent stoma. Eighteen patients (32.1%) had a CCFFIS <9 at the completion of follow-up, and 16 (28.6%) had long-term success. Twenty-four patients evaluated for FIQoL had a mean value of 2.6 (range: 1.0–4.1). Postoperative CCFFIS was correlated with FIQoL (Spearman’s correlation coefficient = −0.854, P < 0.001). Logistic regression analysis did not reveal any significant predictive variables for success of RS. Conclusion: Based on our criteria for success, the long-term success rate for RS over a median of 74 months is poor.