大便失禁患者的骶神经调节：首批100例永久性植入的结果

Sacral neuromodulation in patients with faecal incontinence: results of the first 100 permanent implantations.

作者信息

Melenhorst J, Koch S M, Uludag O, van Gemert W G, Baeten C G

机构信息

Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands.

出版信息

Colorectal Dis. 2007 Oct;9(8):725-30. doi: 10.1111/j.1463-1318.2007.01241.x. Epub 2007 May 17.

DOI:10.1111/j.1463-1318.2007.01241.x

PMID:17509049

Abstract

OBJECTIVE

Faecal incontinence (FI) is a socially devastating problem. Sacral nerve modulation (SNM) has proven its place in the treatment of patients with FI. In this study, the first 100 definitive SNM implants in a single centre have been evaluated prospectively.

METHOD

Patients treated between March 2000 and May 2005 were included. Faecal incontinence was defined as at least one episode of involuntary faecal loss per week confirmed by a 3-week bowel habit diary. Patients were eligible for implantation of a permanent SNM when showing at least a 50% reduction in incontinence episodes or days during ambulatory test stimulation. Preoperative workup consisted of an X-defaecography, pudendal nerve terminal motor latency measurement, endo-anal ultrasound and anal manometry. The follow-up visits for the permanent implanted patients were scheduled at 1, 3, 6 and 12 months and annually thereafter. The bowel habit diary and anal manometry were repeated postoperatively during the follow-up visits.

RESULTS

A total of 134 patients were included and received a subchronic test stimulation. One hundred patients (74.6%) had a positive test stimulation and received a definitive SNM implantation. The permanent implantation group consisted of 89 women and 11 men. The mean age was 55 years (range 26-75). The mean follow-up was 25.5 months (range 2.5-63.2). The mean number of incontinence episodes decreased significantly during the test stimulation (baseline, 31.3; test, 4.4; P < 0.0001) and at follow-up (36 months postoperatively, 4.8; P < 0.0001). There was no significant change in the mean anal resting pressure. The squeeze pressures were significantly higher at 6 months (109.8 mmHg; P = 0.03), 12 months (114.1 mmHg; P = 0.02) and 24 months postoperatively (113.5 mmHg; P = 0.007). The first sensation, urge and maximum tolerable volume did not change significantly. Twenty-one patients were considered late failures and received further treatment.

CONCLUSION

Sacral neuromodulation is an effective treatment for FI. The medium-term results were satisfying.

摘要

目的

大便失禁（FI）是一个对社会有严重不良影响的问题。骶神经调节（SNM）已在FI患者的治疗中证明了其价值。在本研究中，对单一中心的首批100例确定性SNM植入进行了前瞻性评估。

方法

纳入2000年3月至2005年5月期间接受治疗的患者。大便失禁定义为通过为期3周的排便习惯日记确认每周至少有一次非自愿性大便失禁发作。当患者在动态测试刺激期间失禁发作次数或天数至少减少50%时，有资格植入永久性SNM。术前检查包括排粪造影、阴部神经终末运动潜伏期测量、肛门内超声检查和肛门测压。永久性植入患者的随访安排在术后1、3、6和12个月，此后每年进行一次。随访期间术后重复排便习惯日记和肛门测压。

结果

共纳入134例患者并接受了亚慢性测试刺激。100例患者（74.6%）测试刺激呈阳性并接受了确定性SNM植入。永久性植入组包括89名女性和11名男性。平均年龄为55岁（范围26 - 75岁）。平均随访时间为25.5个月（范围2.5 - 63.2个月）。测试刺激期间（基线时为31.3次；测试时为4.4次；P < 0.0001）以及随访时（术后36个月时为4.8次；P < 0.0001）失禁发作的平均次数显著减少。肛门静息压力平均值无显著变化。术后6个月（109.8 mmHg；P = 0.03）、12个月（114.1 mmHg；P = 0.02）和24个月（113.5 mmHg；P = 0.007）时的挤压压力显著更高。首次感觉、便意和最大耐受量无显著变化。21例患者被视为晚期失败并接受了进一步治疗。