Ripetti V, Caputo D, Ausania F, Esposito E, Bruni R, Arullani A
Department of Surgery, Campus Bio-Medico University, Via Emilio Longoni 69, I-00155 Rome, Italy.
Tech Coloproctol. 2002 Dec;6(3):147-52. doi: 10.1007/s101510200034.
There are several therapeutic options for fecal incontinence but often they do not achieve good results in the long run. This study dealt with sacral nerve modulation, a new therapeutic option. Twenty-one patients underwent pudendal nerve evaluation (PNE) at our institution. Nine patients were affected by both fecal and urinary incontinence, 3 had fecal incontinence and anal pain, 5 had fecal incontinence and pelvic floor dyssynergia, and 4 had isolated fecal incontinence. They underwent morphological, functional and psychological tests prior to PNE, showing no sphincter rupture, almost normal anal pressures, impaired rectal sensation and deficient psychological pattern. All patients underwent at least two nerve evaluations. Four of 21 patients (19%) were selected to receive a permanent sacral electrode, as PNE seemed to have improved their symptoms by >75%. A median follow-up of 15 months (range, 6-24 months) showed that this method decreases weekly episodes of incontinence and increases maximal squeeze pressure. We demonstrated an increase in basal pressure in 3 of 4 patients (all with isolated fecal incontinence). Rectal sensation threshold decreased in three patients; urge threshold decreased in two patients and increased in two patients, but in each patient we got a stabilization. We evaluated the quality of life by applying the Short Form Health Survey test (SF-36). All 4 patients showed a significant increase in the scores of physical, emotional and social role functioning after the permanent implant. In conclusion, sacral nerve modulation may improve physical, physiological and social quality of life in selected groups of incontinent patients without gross sphincter lesions and with impaired rectal sensation.
大便失禁有多种治疗选择，但从长远来看，这些方法往往效果不佳。本研究探讨了一种新的治疗方法——骶神经调节。21例患者在我院接受了阴部神经评估（PNE）。9例患者同时存在大便失禁和尿失禁，3例有大便失禁和肛门疼痛，5例有大便失禁和盆底协同失调，4例为单纯性大便失禁。在进行PNE之前，他们接受了形态学、功能和心理测试，结果显示无括约肌破裂，肛门压力基本正常，直肠感觉受损，心理状态欠佳。所有患者均接受了至少两次神经评估。21例患者中有4例（19%）被选中接受永久性骶神经电极植入，因为PNE似乎使他们的症状改善了75%以上。中位随访15个月（范围6 - 24个月）结果显示，该方法减少了每周的失禁发作次数，并增加了最大收缩压。我们发现4例患者中有3例（均为单纯性大便失禁）的基础压力有所增加。3例患者的直肠感觉阈值降低；2例患者的急迫感阈值降低，2例患者的急迫感阈值升高，但每位患者的情况都趋于稳定。我们通过应用简短健康调查测试（SF - 36）评估了生活质量。所有4例患者在永久性植入后，身体、情感和社会角色功能评分均显著提高。总之，骶神经调节可能改善部分特定类型的失禁患者的身体、生理和社会生活质量，这些患者无明显括约肌病变但存在直肠感觉受损。
