Rasmussen Ole O, Buntzen Steen, Sørensen Michael, Laurberg Søren, Christiansen John
Department of Surgery D, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
Dis Colon Rectum. 2004 Jul;47(7):1158-62; discussion 1162-3. doi: 10.1007/s10350-004-0553-8. Epub 2004 May 6.
The effect of sacral nerve stimulation was studied in 45 patients with fecal incontinence.
All patients were initially tested in general anesthesia. Sacral nerves 2, 3, and 4 were tested on both sides. If a perineal/perianal muscular response to sacral nerve stimulation could be obtained, electrodes were implanted for a three-week test-stimulation period. If sacral nerve stimulation resulted in at least a 50 percent reduction in incontinence episodes during the test period, a system for permanent sacral nerve stimulation was implanted.
When tested in general anesthesia, 43 of 45 patients had a muscular response to sacral nerve stimulation and had electrodes implanted for the three-week test period. Percutaneous electrodes were used in 34 patients, and 23 of these had at least a 50 percent reduction in incontinence episodes, whereas the electrodes dislocated in 7 patients and 4 had a poor response. Permanent electrodes with percutaneous extension electrodes were used primarily in 9 patients and after dislocation of percutaneous electrodes in an additional 6 patients; 14 of these had a good result. In the last patient, no clinical response to stimulation with the permanent electrode could be obtained. A permanent stimulation system was implanted in 37 patients. After a median of six (range, 0-36) months follow-up, five patients had the system explanted: three because the clinical response faded out, and two because of infection. Incontinence score (Wexner, 0-20) for the 37 patients with a permanent system for sacral nerve stimulation was reduced from median 16 (range, 9-20) before sacral nerve stimulation to median 6 (range, 0-20) at latest follow-up ( P < 0.0001). There was no differences in effect of sacral nerve stimulation in patients with idiopathic incontinence (n = 19) compared with spinal etiology (n = 8) or obstetric cause of incontinence (n = 5). Sacral nerve stimulation did not influence anal pressures or rectal volume tolerability.
Sacral nerve stimulation in fecal incontinence shows promising results. Patients with idiopathic, spinal etiology, or persisting incontinence after sphincter repair may benefit from this minimally invasive treatment.
研究骶神经刺激对45例大便失禁患者的疗效。
所有患者最初在全身麻醉下进行测试。双侧测试骶神经2、3和4。如果能获得对骶神经刺激的会阴/肛周肌肉反应，则植入电极进行为期三周的测试刺激期。如果骶神经刺激在测试期内导致失禁发作至少减少50%，则植入永久性骶神经刺激系统。
在全身麻醉下进行测试时，45例患者中有43例对骶神经刺激有肌肉反应，并植入电极进行为期三周的测试期。34例患者使用经皮电极，其中23例失禁发作至少减少50%，而7例电极脱位，4例反应不佳。9例患者主要使用带有经皮延长电极的永久性电极，另外6例患者在经皮电极脱位后使用；其中14例效果良好。在最后1例患者中，永久性电极刺激未获得临床反应。37例患者植入了永久性刺激系统。中位随访6（范围0 - 36）个月后，5例患者取出了该系统：3例是因为临床反应消失，2例是因为感染。37例植入永久性骶神经刺激系统的患者的失禁评分（韦克斯纳评分，0 - 20）从骶神经刺激前的中位16（范围9 - 20）降至最近一次随访时的中位6（范围0 - 20）（P < 0.０００１）。特发性失禁患者（n = 19）与脊髓病因（n = 8）或产科原因导致失禁（n = 5）的患者相比，骶神经刺激的效果没有差异。骶神经刺激不影响肛门压力或直肠容量耐受性。
骶神经刺激治疗大便失禁显示出有前景的结果。特发性、脊髓病因或括约肌修复后仍存在失禁的患者可能从这种微创治疗中获益。
