Ruthmann O, Fischer A, Hopt U T, Schrag H J
Abteilung für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Hugstetter Strasse 55, 79106 Freiburg im Breisgau.
Chirurg. 2006 Oct;77(10):926-38. doi: 10.1007/s00104-006-1217-0.
Dynamic graciloplasty (DGP) and the Acticon Neosphincter (artificial bowel sphincter, ABS) are well-established therapeutic instruments in patients with severe fecal incontinence. However, the success rates in the literature must be interpreted with caution. The report presented here presents firstly a critical analysis of 1510 patients in 52 studies (29 DGP vs 23 ABS). The evidence of these studies was assessed using the Oxford EBM criteria. All data were statistically analysed. Up to 94% of the studies analysed show EBM levels of only >3b. Both procedures show significant improvements in postoperative continence scores (p<0.001) and a significant advantage of ABS over DGP. Nevertheless, they are associated with a high incidence of morbidity in the long term (infection rate ABS vs DGP 21.74% vs 35.1%, revision rate ABS vs DGP 37.53% vs 40.64%, and ABS explantation rates of 30%). Presently no therapeutic recommendation can be expressed based on the few data available. Furthermore, therapy should be performed in specialized centers and patients should be given a realistic picture of the critical outcome of both surgical techniques.
动态股薄肌成形术（DGP）和Acticon新括约肌（人工肠括约肌，ABS）是治疗严重大便失禁患者的成熟治疗手段。然而，对于文献中的成功率必须谨慎解读。本文首先对52项研究中的1510例患者（29例DGP与23例ABS）进行了批判性分析。使用牛津循证医学标准评估这些研究的证据。所有数据均进行了统计学分析。高达94%的分析研究显示循证医学水平仅>3b。两种手术在术后控便评分方面均有显著改善（p<0.001），且ABS相对于DGP具有显著优势。然而，从长期来看，它们都伴有较高的发病率（ABS与DGP的感染率分别为21.74%和35.1%，翻修率分别为37.53%和40.64%，ABS取出率为30%）。目前，基于现有的少量数据无法给出治疗建议。此外，治疗应在专业中心进行，并且应向患者如实说明两种手术技术的关键结果。
