Parker Susan C, Spencer Michael P, Madoff Robert D, Jensen Linda L, Wong W Douglas, Rothenberger David A
Departments of Surgery, University of Minnesota, St. Paul, USA.
Dis Colon Rectum. 2003 Jun;46(6):722-9. doi: 10.1097/01.DCR.0000070530.79998.86.
This study was undertaken to evaluate a single-institution experience with the Acticon artificial bowel sphincter for the treatment of intractable fecal incontinence.
At the University of Minnesota, 45 consecutive patients underwent artificial bowel sphincter placement (Group I, 1989-1992, n = 10; Group II, 1997-2001, n = 35). Group I was reviewed retrospectively and Group II prospectively.
The outcome for Group I patients was initially reported in 1995 (mean age, 32; range, 15-52 years; 7 males). Of these 10 patients, 4 required explantation (2 required stomas), and 6 have a functional artificial bowel sphincter; 2 patients had devices successfully replaced for fluid leaks (at 6 and 10 years). In Group II, artificial bowel sphincter placement was attempted in 37 patients and was successful in 35 (mean age, 47; range, 18-72 years; 11 males). A total of 14 patients required explantation, 12 (34 percent) for infection and 2 (6 percent) for pain. In total, 13 patients have required 21 revisions, including 7 complete device replacements. The infection rate for revisions was 19 percent; four patients required explantation after revisions. Of 18 patients whose artificial bowel sphincter failed, 9 required a stoma. In all, 17 (49 percent) patients have a functional artificial bowel sphincter. In Group II fecal incontinence severity scores decreased from a mean of 103 preimplant to 59 at one year and to 23 at two or more years (P < 0.001) in patients who retained their devices. Quality of life scores improved in all patients at six months and at one year (P < 0.01).
Artificial bowel sphincter therapy leads to long-term improved continence and quality of life in patients whose implantation is successful. Success rates have not improved in the two patient groups, with infection remaining a major challenge. However, once successfully established, artificial bowel sphincter function remains stable for many years.
本研究旨在评估单机构使用Acticon人工肛门括约肌治疗顽固性大便失禁的经验。
在明尼苏达大学，45例连续患者接受了人工肛门括约肌植入术（第一组，1989 - 1992年，n = 10；第二组，1997 - 2001年，n = 35）。第一组进行回顾性分析，第二组进行前瞻性分析。
第一组患者的结果最初于1995年报告（平均年龄32岁；范围15 - 52岁；7例男性）。这10例患者中，4例需要取出装置（2例需要造口），6例拥有功能性人工肛门括约肌；2例患者因液体渗漏成功更换装置（分别在6年和10年时）。在第二组中，37例患者尝试植入人工肛门括约肌，35例成功（平均年龄47岁；范围18 - 72岁；11例男性）。共有14例患者需要取出装置，12例（34%）因感染，2例（6%）因疼痛。总共13例患者需要21次翻修，包括7次完全更换装置。翻修的感染率为19%；4例患者翻修后需要取出装置。在18例人工肛门括约肌失效的患者中，9例需要造口。总体而言，17例（49%）患者拥有功能性人工肛门括约肌。在第二组中，保留装置的患者大便失禁严重程度评分从植入前的平均103分降至1年后的59分，以及2年或更长时间后的23分（P < 0.001）。所有患者在6个月和1年时生活质量评分均有所改善（P < 0.01）。
人工肛门括约肌治疗可使植入成功的患者长期改善控便能力和生活质量。两组患者的成功率未提高，感染仍然是一个主要挑战。然而，一旦成功建立，人工肛门括约肌功能多年来保持稳定。
