Shafik Ahmed, El Sibai Olfat, Shafik Ismail A, Shafik Ali A
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt.
Am Surg. 2007 Jan;73(1):6-9.
The authors investigated the hypothesis that partial fecal incontinence (PFI) had variable manifestations that can be categorized as different types of PFI with different pathogeneses and treatment. Anal and rectal pressures as well as external and internal anal sphincter electromyographic activity were recorded in 163 patients with PFI and in 25 healthy volunteers. Patients were treated with biofeedback or surgically. Three types of PFI were encountered: stress fecal incontinence (SFI; 55 patients), urge fecal incontinence (UFI; 72 patients), and mixed fecal incontinence (MFI; 36 patients). Anal pressure decreased in three groups in which MFI had the lowest pressure. A significant reduction in external anal sphincter electromyographic activity occurred in SFI, in internal anal sphincter electromyographic activity in UFI, and of both sphincters in MFI. Biofeedback cured 36 of 55 patients and postanal repair cured 10 of 19 patients with SFI. Forty-eight of 72 patients with UFI responded to biofeedback and 16 of 24 responded to internal anal sphincter repair. Biofeedback failed in MFI patients. Twenty-four of 27 patients who consented to operative correction of the sphincteric defect were cured. Three types of PFI could be identified: SFI, UFI, and MFI. Each type has its own etiology and symptoms, and requires individual treatment. Biofeedback succeeded in treating the majority of SFI and UFI patients. Surgical correction of the anal sphincter was performed after biofeedback failure.
部分粪便失禁（PFI）有多种表现形式，可根据不同的发病机制和治疗方法分为不同类型的PFI。对163例PFI患者和25名健康志愿者记录了肛门和直肠压力以及肛门外括约肌和内括约肌的肌电图活动。患者接受了生物反馈治疗或手术治疗。发现了三种类型的PFI：压力性粪便失禁（SFI；55例患者）、急迫性粪便失禁（UFI；72例患者）和混合性粪便失禁（MFI；36例患者）。三组患者的肛门压力均下降，其中MFI组压力最低。SFI组肛门外括约肌肌电图活动显著降低，UFI组肛门内括约肌肌电图活动显著降低，MFI组两组括约肌肌电图活动均降低。生物反馈治疗使55例SFI患者中的36例治愈，肛门后修复使19例SFI患者中的10例治愈。72例UFI患者中有48例对生物反馈有反应，24例中有16例对内括约肌修复有反应。生物反馈对MFI患者无效。27例同意手术矫正括约肌缺陷的患者中有24例治愈。可识别出三种类型的PFI：SFI、UFI和MFI。每种类型都有其自身病因和症状，需要个体化治疗。生物反馈成功治疗了大多数SFI和UFI患者。生物反馈治疗失败后进行了肛门括约肌的手术矫正。
