Baeten C G, Bailey H R, Bakka A, Belliveau P, Berg E, Buie W D, Burnstein M J, Christiansen J, Coller J A, Galandiuk S, LaFontaine L J, Lange J, Madoff R D, Matzel K E, Påhlman L, Parc R, Reilly J C, Seccia M, Thorson A G, Vernava A M, Wexner S
Department of Surgery, Academic Hospital Maastricht, The Netherlands.
Dis Colon Rectum. 2000 Jun;43(6):743-51. doi: 10.1007/BF02238008.
Dynamic graciloplasty has been used for intractable fecal incontinence, and good results have been reported. The aim of this study was to assess prospectively the safety and efficacy of dynamic graciloplasty for intractable fecal incontinence in a prospective, multicenter trial.
A total of 123 adults were treated with dynamic graciloplasty at 20 institutions. Continence was assessed preoperatively and postoperatively by use of 14-day diaries.
There was one treatment-related death. One hundred eighty-nine adverse events occurred in 91 patients (74 percent). Forty-nine patients (40 percent) required one or more operations to treat complications. One hundred seventy (90 percent) events were resolved. Sixty-three percent of patients without pre-existing stomas recorded a 50 percent or greater decrease in incontinent events 12 months after dynamic graciloplasty, and an additional 11 percent experienced lesser degrees of improvement. Twenty-six percent were not improved, worsened, or exited. In patients with pre-existing stomas, 33 percent achieved successful outcomes at 12 months. This number increased to 60 percent at 18 months. Seventy-eight percent of patients had increased enema retention time, and mean anal canal pressures improved significantly at 12 months. Significant changes in quality of life were also observed.
Objective improvement can be demonstrated in the majority of patients with end-stage fecal incontinence treated with dynamic graciloplasty. Reduction in incontinence episodes can be correlated with improved quality of life. Adverse events are frequently encountered, but most resolve with treatment.
动力性股薄肌成形术已用于治疗顽固性大便失禁，且已有报道称效果良好。本研究的目的是在前瞻性多中心试验中，对动力性股薄肌成形术治疗顽固性大便失禁的安全性和有效性进行前瞻性评估。
20家机构共对123名成年人实施了动力性股薄肌成形术。术前和术后通过14天的排便日记对控便情况进行评估。
发生了1例与治疗相关的死亡。91名患者（74%）出现了189起不良事件。49名患者（40%）需要进行一次或多次手术来治疗并发症。170起（90%）事件得到解决。在术前无造口的患者中，63%在动力性股薄肌成形术后12个月记录到失禁事件减少了50%或更多，另有11%的患者改善程度较小。26%的患者没有改善、病情恶化或退出研究。在术前有造口的患者中，33%在12个月时取得了成功的治疗效果。这一数字在18个月时增至60%。78%的患者灌肠保留时间延长，肛管压力在12个月时显著改善。生活质量也有显著变化。
大多数接受动力性股薄肌成形术治疗的终末期大便失禁患者可出现客观改善。失禁发作次数的减少与生活质量的改善相关。不良事件经常发生，但大多数经治疗后可得到解决。
