Michelsen Hanne B, Buntzen Steen, Krogh Klaus, Laurberg Søren
Surgical Research Unit, Department of Surgery L, Aarhus University Hospital, Aarhus Sygehus, Tage-Hansens Gade, Denmark.
Dis Colon Rectum. 2006 Jul;49(7):1039-44. doi: 10.1007/s10350-006-0548-8.
Sacral nerve stimulation has proven to be a promising treatment for fecal incontinence when conventional treatment modalities have failed. There have been several hypotheses concerning the mode of action of sacral nerve stimulation, but the mechanism is still unclear. This study was designed to evaluate the results of rectal volume tolerability, rectal pressure-volume curves, and anal pressures before and six months after permanent sacral nerve stimulation and to investigate the mode of action of sacral nerve stimulation.
Twenty-nine patients with incontinence (male/female ratio = 6/23; median age, 58 (range, 29-79) years) underwent implantation of a permanent sacral electrode and neurostimulator after a positive percutaneous nerve evaluation test. Wexner incontinence score, rectal distention with thresholds for "first sensation," "desire to defecate," and "maximal tolerable volume," rectal pressure-volume curves, anal resting pressure, and maximum squeeze pressure were evaluated at baseline and at six months follow-up.
Median Wexner incontinence score decreased from 16 (range, 6-20) to 4 (range, 0-12; P < 0. 0001). Median "first sensation" increased from 43 (range, 16-230) ml to 62 (range, 4-186) ml (P = 0.1), median "desire to defecate" from 70 (range, 30-443) ml to 98 (range, 30-327) ml (P = 0.011), and median "maximal tolerable volume" from 130 (range, 68-667) ml to 166 (range, 74-578) ml (P = 0.031). Rectal pressure-volume curves showed a significant increase in rectal capacity (P < 0.0001). The anal resting pressure increased significantly from 31 (range, 0-109) cm H(2)O to 38 (range, 0-111) cm H(2)O (P = 0.045). No significant increase in maximum squeeze pressure was observed.
For patients with fecal incontinence successfully treated with sacral nerve stimulation, there was a significant increase in rectal volume tolerability and rectal capacity. A significant increase in anal resting pressure, but not in maximum squeeze pressure, was found. We suggest that sacral nerve stimulation causes neuromodulation at spinal level.
当传统治疗方式无效时，骶神经刺激已被证明是一种有前景的大便失禁治疗方法。关于骶神经刺激的作用方式有几种假说，但机制仍不清楚。本研究旨在评估永久性骶神经刺激前后及六个月后直肠容量耐受性、直肠压力 - 容量曲线和肛门压力的结果，并研究骶神经刺激的作用方式。
29例大便失禁患者（男/女比例 = 6/23；中位年龄58岁（范围29 - 79岁））在经皮神经评估试验呈阳性后接受了永久性骶神经电极和神经刺激器植入。在基线和六个月随访时评估韦克斯纳失禁评分、直肠扩张时的“首次感觉”“排便欲望”和“最大耐受容量”阈值、直肠压力 - 容量曲线、肛门静息压力和最大收缩压力。
韦克斯纳失禁评分中位数从16（范围6 - 20）降至4（范围0 - 12；P < 0.0001）。“首次感觉”中位数从43（范围16 - 230）ml增加到62（范围4 - 186）ml（P = 0.1），“排便欲望”中位数从70（范围30 - 443）ml增加到98（范围30 - 327）ml（P = 0.011），“最大耐受容量”中位数从130（范围68 - 667）ml增加到166（范围74 - 578）ml（P = 0.031）。直肠压力 - 容量曲线显示直肠容量显著增加（P < 0.0001）。肛门静息压力从31（范围0 - 109）cmH₂O显著增加到38（范围0 - 111）cmH₂O（P = 0.045）。未观察到最大收缩压力有显著增加。
对于经骶神经刺激成功治疗的大便失禁患者，直肠容量耐受性和直肠容量显著增加。发现肛门静息压力显著增加，但最大收缩压力未增加。我们认为骶神经刺激在脊髓水平引起神经调节。
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