Leroi A M, Dorival M P, Lecouturier M F, Saiter C, Welter M L, Touchais J Y, Denis P
Groupe de Recherche sur l'Appareil Digestif, Hôpital Charles Nicolle, Rouen, France.
Dis Colon Rectum. 1999 Jun;42(6):762-9. doi: 10.1007/BF02236932.
It has been suggested that the severity of fecal incontinence, the presence of pudendal neuropathy, or an external anal sphincter defect does not preclude clinical improvement with biofeedback therapy. A discrepancy, however, is frequently found between subjective improvement and objective results after biofeedback therapy. Our aim was to assess whether severity of fecal incontinence, presence of pudendal neuropathy, or an external anal sphincter defect could influence the results of manometric parameters after biofeedback therapy in patients with fecal incontinence.
Biofeedback therapy was used to treat 27 patients with fecal incontinence (25 women; mean age, 53; range, 29-74 years), according to a strict protocol. Manometry, pudendal nerve terminal motor latency, and anal ultrasound were performed in all patients before biofeedback therapy. Manometric evaluation of external anal sphincter function was performed after the biofeedback sessions.
Eight of 27 patients had a good clinical response to biofeedback, but with no significant difference in their mean amplitude and duration of squeeze pressure before and after biofeedback. There was no relationship between the clinical results of biofeedback therapy and the initial severity of fecal incontinence, pudendal neuropathy, or external sphincter defect. Patients with severe incontinence (incontinence to solids) and pudendal neuropathy failed to improve the amplitude and duration of their maximum voluntary contraction after biofeedback therapy. Patients with mild fecal incontinence (incontinence to flatus, liquids, or both) (P<0.04), without pudendal neuropathy (P<0.02), or with (P<0.05) and without (P<0.05) external sphincter defect improved their external anal sphincter function after biofeedback therapy.
In patients with fecal incontinence, the severity of symptoms and pudendal neuropathy should be considered as two factors of poor prognosis of favorable manometric results after biofeedback therapy. Improvement, on the other hand, may be expected after biofeedback therapy despite an external anal sphincter defect.
有人提出，粪失禁的严重程度、阴部神经病变的存在或肛门外括约肌缺陷并不妨碍生物反馈疗法取得临床改善。然而，生物反馈疗法后主观改善与客观结果之间经常存在差异。我们的目的是评估粪失禁的严重程度、阴部神经病变的存在或肛门外括约肌缺陷是否会影响粪失禁患者生物反馈疗法后测压参数的结果。
根据严格方案，采用生物反馈疗法治疗27例粪失禁患者（25例女性；平均年龄53岁；范围29 - 74岁）。所有患者在生物反馈疗法前均进行测压、阴部神经终末运动潜伏期测定和肛门超声检查。生物反馈治疗后进行肛门外括约肌功能的测压评估。
27例患者中有8例对生物反馈有良好的临床反应，但生物反馈前后其平均挤压压力幅度和持续时间无显著差异。生物反馈疗法的临床结果与粪失禁的初始严重程度、阴部神经病变或外括约肌缺陷之间无相关性。重度失禁（对固体粪便失禁）和阴部神经病变的患者在生物反馈疗法后未能改善其最大自主收缩的幅度和持续时间。轻度粪失禁（对气体、液体或两者均失禁）的患者（P<0.04）、无阴部神经病变的患者（P<0.02）、有（P<0.05）和无（P<0.05）肛门外括约肌缺陷的患者在生物反馈疗法后改善了其肛门外括约肌功能。
在粪失禁患者中，症状的严重程度和阴部神经病变应被视为生物反馈疗法后测压结果良好预后不良的两个因素。另一方面，尽管存在肛门外括约肌缺陷，但生物反馈疗法后仍可能预期会有改善。
