Functional asymmetry of pelvic floor innervation and its role in the pathogenesis of fecal incontinence
Functional asymmetry of pelvic floor innervation and its role in the pathogenesis of fecal incontinence
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DOI：
10.1159/000077876
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发表时间：
2004-01-01
期刊：
影响因子：
3.2
通讯作者：
Becker, HD
中科院分区：
文献类型：
--
作者：
Enck, P;Hinninghofen, H;Becker, HD
虽然规则和对称的神经支配的骨盆底已被认为是“建立”了很多年，最近的数据表明，不对称的神经支配的括约肌可能存在，并可能有助于失禁症状的发生和严重程度的情况下，骨盆底创伤。研究方法：对已发表的关于括约肌神经支配不对称的论文进行了系统综述，包括健康志愿者和失禁患者的研究。本文对234例大便失禁患者进行了左侧、右侧肛管分离性块体表面肌电图检查，并与临床及既往病史相对照。结果如下：文献调查表明，在一个亚组的健康男性和女性志愿者中存在括约肌神经支配的不对称性，并且可能是在创伤情况下发生失禁的危险因素。肛门括约肌神经支配不对称的失禁患者更常报告分娩时骨盆底创伤史。分娩本身而不是分娩次数预测括约肌不对称。非对称神经支配的括约肌在常规肛门直肠测压中显示出括约肌功能受损。结论：括约肌神经支配不对称性的评估可能是有价值的，在临床常规测试失禁患者。然而，需要一种新的技术来取代大量的表面肌电图的多电极阵列上的括约肌探针。这是欧盟赞助的研究项目OASIS的目标之一。版权所有（C）2004 S. Karger AG，巴塞尔。
While the regular and symmetric innervation of the pelvic floor has been regarded as 'established' for many years, recent data indicate that asymmetry of innervation of the sphincters may exists and may contribute to the occurrence and severity of incontinence symptoms in case of pelvic floor trauma. Methods: A systematic review of published papers on asymmetry of sphincter innervation was performed including studies in healthy volunteers and patients with incontinence. 234 consecutive patients with fecal incontinence were investigated by means of side-separated mass surface EMG from the left and right side anal canal, these data were correlated to clinical and anamnestic findings. Results: The literature survey indicates that asymmetry of sphincter innervation exists in a subgroup of healthy male and female volunteers, and may be a risk factor to become incontinent in case of trauma. Patients with incontinence in whom asymmetry of sphincter innervation could be shown more frequently reported a history of pelvic floor trauma during childbirth. Childbirth per se but not the number of deliveries predicted sphincter asymmetry. Asymmetrically innervated sphincters show a compromised sphincter function in routine anorectal manometry. Conclusion: Assessment of sphincter innervation asymmetry may be of value in clinical routine testing of patients with incontinence. However, a new technology is needed to replace mass surface EMG by multi-electrode arrays on a sphincter probe. This is one of the goals of the EU-sponsored research project OASIS. Copyright (C) 2004 S. Karger AG, Basel.