Matzel K E, Bittorf B, Stadelmaier U, Hohenberger W
Chirurgische Klinik mit Poliklinik der Universität Erlangen-Nürnberg, Erlangen.
Chirurg. 2003 Jan;74(1):26-32. doi: 10.1007/s00104-002-0562-x.
Sacral nerve stimulation is a recent development in the treatment of faecal incontinence. This paper reports the experiences of a single center on the use of this technique since its first application.
Based on the functional results of a temporary test stimulation phase, 16 patients underwent operative implantation of a permanent neurostimulation device. Due to a functional deficit of the morphologically intact anal sphincter, all patients suffered from incontinence for liquid and solid stool. The aetiology varied among the patients. The median duration of symptoms was 8.5 years (2-30). Clinical function was evaluated by standardized questionnaires, the Cleveland Clinic incontinence score and the disease specific quality of life instrument (FIQL-ASCRS) before and during stimulation. Anorectal physiology was tested by anorectal manometry.
Functional improvement was achieved in 94% of the patients. At a median follow-up of 32.5 months (3-99) treatment was successful in 81%. The percentage of incontinent bowel movements decreased from a median of 40% (5-100) before stimulation to 0% (0-20) with stimulation ( P=0.001). The Cleveland Clinic incontinence score improved from a median of 17 (11-20) to 5 (0-15) ( P=0.003). The quality of life index was improved in all categories.Mean squeeze pressure was increased form a median of 44 to 75 mmHg with stimulation ( P=0.003) and maximal squeeze pressure from a median of 69 to 97 mmHg (P=0.009). Resting pressure, perception, urge threshold and maximum tolerable volume were not significantly changed.
Sacral nerve stimulation is an effective treatment for faecal incontinence. Morbidity is low. Sacral nerve stimulation is indicated, if conservative treatment fails and more conventional surgical approaches are of limited success.
骶神经刺激是治疗大便失禁的一项最新进展。本文报告了一个单一中心自首次应用该技术以来的使用经验。
基于临时测试刺激阶段的功能结果，16例患者接受了永久性神经刺激装置的手术植入。由于形态完整的肛门括约肌存在功能缺陷，所有患者均有液体和固体粪便失禁。患者的病因各不相同。症状的中位持续时间为8.5年（2 - 30年）。在刺激前和刺激期间，通过标准化问卷、克利夫兰诊所失禁评分和疾病特异性生活质量工具（FIQL - ASCRS）对临床功能进行评估。通过肛门直肠测压法测试肛门直肠生理学。
94%的患者实现了功能改善。在中位随访32.5个月（3 - 99个月）时，81%的治疗取得成功。失禁排便的百分比从中位值40%（刺激前5% - 100%）降至刺激时的0%（0% - 20%）（P = 0.001）。克利夫兰诊所失禁评分从中位值17（11 - 20）改善至5（0 - 15）（P = 0.003）。生活质量指数在所有类别中均得到改善。平均挤压压力在刺激时从中位值44 mmHg增加至75 mmHg（P = 0.003），最大挤压压力从中位值69 mmHg增加至97 mmHg（P = 0.00９）。静息压力、感觉、排尿阈值和最大耐受量均无显著变化。
骶神经刺激是治疗大便失禁的有效方法。发病率低。如果保守治疗失败且更传统的手术方法取得的成功有限，则表明可采用骶神经刺激治疗。
