Lehur Paul-Antoine, Zerbib Frank, Neunlist Michel, Glemain Pascal, Bruley des Varannes Stanislas
Clinique chirurgicale II, Hôtel-Dieu, Nantes, France.
Dis Colon Rectum. 2002 Apr;45(4):508-13. doi: 10.1007/s10350-004-6230-0.
Quality of life, a major outcome parameter in the treatment of anal incontinence, has not been assessed after artificial sphincter implantation. The purpose of this single-center, prospective, nonrandomized study was to assess quality-of-life differences in patients before and after artificial sphincter implantation and compare them with clinical incontinence scores and anal manometry.
Quality of life was assessed in 16 patients (14 females; mean age, 43 years) consecutively implanted with an Acticon Neosphincter. The Fecal Incontinence Quality of Life Scale, a quality-of-life instrument specifically designed for analysis of anal incontinence, included 27 items grouped in four domains: lifestyle, coping/behavior, depression/self-perception, and embarrassment. Fecal Incontinence Quality of Life Scale score (0 to 1, with 1 indicating better quality of life) was calculated preoperatively and postoperatively and compared with the Fecal Incontinence Score (on a scale of 0 to 120, with 120 being complete incontinence), an evacuation score, and maximal resting pressure.
At a mean (standard deviation) of 25 (15) months,12 patients had an activated device, and 11 had satisfactory anorectal function. Significant improvement was observed postoperatively in the four separate quality-of-life domains. Mean (standard deviation) Fecal Incontinence Quality of Life Scale scores increased from 0.44 (0.14) preoperatively to 0.86 (0.18), 0.94 (0.06), and 0.83 (0.16) at 6, 12, and 24 months after implantation, respectively. For the same time periods, the mean (standard deviation) Fecal Incontinence Scores were 105 (14), 24 (26), 32 (35), and 32 (28), respectively (P< 0.05). A linear correlation was found between the improvement over time in quality of life measured by the Fecal Incontinence Quality of Life Scale and clinical evaluation of incontinence measured by the Fecal Incontinence Score (r2 = 0.97; P = 0.03). Mean (standard deviation) maximal resting pressure increased similarly from 42 (24) cm H2O preoperatively to 97 (23) cm H2O at the end of follow-up (P < 0.0001).
After artificial sphincter implantation, quality of life as assessed by a new Fecal Incontinence Quality of Life Scale instrument was significantly improved. These results correlated with clinical assessment of anal incontinence and were associated with a significant increase in maximal anal resting pressure on manometry.
生活质量是肛门失禁治疗中的一个主要结局参数，人工括约肌植入术后尚未对其进行评估。本单中心、前瞻性、非随机研究的目的是评估人工括约肌植入术前和术后患者的生活质量差异，并将其与临床失禁评分和肛门测压结果进行比较。
对16例（14例女性；平均年龄43岁）连续植入Acticon新括约肌的患者进行生活质量评估。粪便失禁生活质量量表是一种专门设计用于分析肛门失禁的生活质量工具，包括27个项目，分为四个领域：生活方式、应对/行为、抑郁/自我认知和尴尬。术前和术后计算粪便失禁生活质量量表评分（0至1，1表示生活质量更好），并与粪便失禁评分（范围为0至120，120表示完全失禁）、排空评分和最大静息压力进行比较。
平均（标准差）25（15）个月时，12例患者的装置已激活，11例患者的肛肠功能良好。术后四个生活质量领域均观察到显著改善。粪便失禁生活质量量表评分平均（标准差）从术前的0.44（0.14）分别提高到植入后6、12和24个月时的0.86（0.18）、0.94（0.06）和0.83（0.16）。在相同时间段内，粪便失禁评分平均（标准差）分别为105（14）、24（26）、32（35）和32（28）（P<0.05）。通过粪便失禁生活质量量表测量的生活质量随时间的改善与通过粪便失禁评分测量的失禁临床评估之间发现线性相关性（r2 = 0.97；P = 0.03）。平均（标准差）最大静息压力也类似地从术前的42（24）cm H2O增加到随访结束时的97（23）cm H2O（P < 0.0001）。
人工括约肌植入术后，通过一种新的粪便失禁生活质量量表工具评估的生活质量得到显著改善。这些结果与肛门失禁的临床评估相关，并且与测压时最大肛门静息压力的显著增加有关。
