The functional outcome of sacral nerve stimulation for faecal incontinence can be improved by using lead model 3889 and a standardized implantation technique
The functional outcome of sacral nerve stimulation for faecal incontinence can be improved by using lead model 3889 and a standardized implantation technique
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DOI：
10.1111/codi.14234
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发表时间：
2018-06-01
影响因子：
3.4
通讯作者：
Lundby, L.
中科院分区：
文献类型：
--
作者：
Duelund-Jakobsen, J.;Laurberg, S.;Lundby, L.
目的骶神经刺激术是保守治疗无效的大便失禁的有效治疗方法。改进手术技术和使用弯型探针可改善功能结局。我们的目的是探讨导线型号、功能结果、刺激幅度和第一年随访期间额外访视需求之间的关系。方法从2009年5月至2017年2月的患者数据中提取并分析导线型号和尿失禁评分改善之间的差异，结果134例患者使用3093型椎间孔电极导线（直型探针），40例患者使用3889型电极导线（弯型探针）。基线特征或尿失禁评分无差异。比较两种电极导线型号之间的结果，我们发现植入电极导线型号3889（弯型探针）的患者在6个月随访时的Wexner评分（P=0.05）和12个月随访时的St Mark评分（P=0.02）的改善（δ值）大于植入电极导线型号3093（直型探针）的患者。植入3889型电极导线（弯曲探针）的患者在第一年随访期间不太可能改变刺激振幅或电极配置（P=0.04）。结论3889型电极导线（弯型探针）与3093型电极导线（直型探针）相比，在术后第1年随访时，可改善患者的功能。3889型电极导线（弯曲探针）减少了重新程控的需要，但对刺激幅度或所需的额外访视次数没有影响。
Aim Sacral nerve stimulation has been recognized as an effective treatment option for faecal incontinence when conservative therapy has failed. Refinement of the procedural technique and the use of a curved stylet may improve the functional outcome. Our aim was to explore the relationship between lead model, functional outcome, stimulation amplitude and the need for extra visits during the first year of follow-up.Method Patient data from May 2009 to February 2017, which were prospectively collected in a local database, were extracted and analysed for differences between lead model and improvement in incontinence scores, stimulation amplitude and the need for additional visits during the first year of follow-up.Results A foramen lead model 3093(straight stylet) was used in 134 patients and lead model 3889(curved stylet) was used in 40 patients. There were no differences in baseline characteristics or incontinence scores. Comparing results between the two lead models we found that the improvement (delta value) in the Wexner score at 6 months' follow-up (P=0.05) and the St Mark's score at 12 months' follow-up (P=0.02) was greater in patients implanted with lead model 3889(curved stylet) compared with patients implanted with lead model 3093(straight stylet). Patients implanted with lead model 3889 (curved stylet) were less likely to have to alter the stimulation amplitude or pole configuration during the first year of follow-up (P=0.04). No difference was found for stimulation amplitude (P=0.170) or the need for additional visits (P=0.663).Conclusion Lead model 3889 (curved stylet) improves functional results compared with lead model 3093 (straight stylet) during the first year of follow-up. Lead model 3889 (curved stylet) reduces the need for reprogramming but has no influence on stimulation amplitude or the number of additional visits required.