Tan Jane J Y, Chan Miranda, Tjandra Joe J
Department of Colorectal Surgery, Royal Melbourne Hospital, Melbourne, Australia.
Dis Colon Rectum. 2007 Nov;50(11):1950-67. doi: 10.1007/s10350-007-9009-2.
Fecal incontinence is common and can be socially debilitating. Nonoperative management of fecal incontinence includes dietary modification, antidiarrheal medication, and biofeedback. The traditional surgical approach is sphincteroplasty if there is a defect of the external sphincter. Innovative treatment modalities have included sacral nerve stimulation, injectable implants, dynamic graciloplasty, and artificial bowel sphincter.
This review was designed to assess the various surgical options available for fecal incontinence and critically evaluate the evidence behind these procedures. The algorithm in the surgical treatment of fecal incontinence is shifting. Injectable therapy and sacral nerve stimulation are likely to be the mainstay in future treatment of moderate and severe fecal incontinence, respectively. Sphincteroplasty is limited to a small group of patients with isolated defect of the external sphincter. A stoma, although effective, can be avoided in most cases.
大便失禁很常见，会给患者带来社交障碍。大便失禁的非手术治疗方法包括饮食调整、止泻药物和生物反馈疗法。如果存在外括约肌缺陷，传统的手术方法是括约肌成形术。创新的治疗方式包括骶神经刺激、可注射植入物、动态股薄肌成形术和人工肛门括约肌。
本综述旨在评估大便失禁的各种手术选择，并严格评估这些手术背后的证据。大便失禁手术治疗的算法正在发生变化。可注射治疗和骶神经刺激可能分别成为未来中重度大便失禁治疗的主要手段。括约肌成形术仅限于一小部分存在孤立性外括约肌缺陷的患者。造口术虽然有效，但在大多数情况下可以避免。
