Uludag O, Koch S M P, Dejong C H C, van Gemert W G, Baeten C G M I
University Hospital Maastricht, Department of General Surgery PO Box 5800 6202 AZ Maastricht, the Netherlands.
Colorectal Dis. 2006 May;8(4):318-22. doi: 10.1111/j.1463-1318.2005.00930.x.
Sacral neuromodulation (SNM) has been a successful treatment in urinary voiding disorders for years. A concomitant effect on bowel function was observed leading to the treatment of faecal incontinence with SNM. In this study we describe the effect of SNM on bowel frequency and (segmental) colonic transit time.
Fourteen patients with faecal incontinence who qualified for permanent SNM underwent a colon transit study before and one month after permanent implant. Patients completed a three-week bowel habits diary before and during stimulation.
Median incontinence episodes and days per week before SNM were, 8.7 and 4.2, respectively, and both decreased significantly to 0.67 (P = 0001) and 0.5 (P = 0001) during trial screening and to 0.33 (P = 0001) and 0.33 (P = 0001) after permanent implant. The median number of bowel movements per week decreased from 14.7 (6.7-41.7) to 10.0 (3.7-22.7)(P = 0005) during trial screening and to 10.0 (6.0-24.3)(P = 0008) during permanent stimulation. Resting and squeeze pressures did not change significantly during stimulation. Segmental colonic transit time before and during stimulation for right colon, left colon and recto sigmoid were, respectively, 6 (0-25) vs 5 (0-16) hours, 2 (0-29) vs 4 (0-45) hours and 7 (28) vs 8 (0-23) hours. No significant changes were found in both segmental and total colonic transit time; 17 (1-65) vs 25 (0-67) hours.
SNM in patients with fecal incontinence led to a significant decrease of bowel movements however (segmental) colonic transit time was not influenced.
多年来，骶神经调节（SNM）一直是治疗排尿障碍的一种成功方法。人们观察到它对肠道功能有连带作用，从而将SNM用于治疗大便失禁。在本研究中，我们描述了SNM对排便频率和（节段性）结肠运输时间的影响。
14名符合永久性SNM治疗条件的大便失禁患者在永久性植入前及植入后1个月进行了结肠运输研究。患者在刺激前及刺激期间完成了一份为期三周的排便习惯日记。
SNM治疗前，失禁发作的中位数和每周失禁天数分别为8.7次和4.2天，在试验筛查期间均显著降至0.67次（P = 0.001）和0.5天（P = 0.001），永久性植入后降至0.33次（P = 0.001）和0.33天（P = 0.001）。每周排便次数的中位数在试验筛查期间从14.7次（6.7 - 41.7次）降至10.0次（3.7 - 22.7次）（P = 0.005），在永久性刺激期间降至10.0次（6.0 - 24.3次）（P = 0.008）。刺激期间静息压力和挤压压力无显著变化。刺激前及刺激期间，右半结肠、左半结肠和直肠乙状结肠的节段性结肠运输时间分别为6（0 - 25）小时对5（0 - 16）小时、2（0 - 29）小时对4（0 - 45）小时和7（2 - 8）小时对8（0 - 23）小时。节段性和全结肠运输时间均未发现显著变化；17（1 - 65）小时对25（0 - 67）小时。
大便失禁患者接受SNM治疗后排便次数显著减少，然而（节段性）结肠运输时间未受影响。
