骶神经刺激作为马尾综合征患者大便失禁的一种治疗选择。
Sacral nerve stimulation as an option for the treatment of faecal incontinence in patients suffering from cauda equina syndrome.
作者信息
Gstaltner K, Rosen H, Hufgard J, Märk R, Schrei K
机构信息
Centre of Rehabilitation Weisser Hof, Klosterneuburg, Austria.
出版信息
Spinal Cord. 2008 Sep;46(9):644-7. doi: 10.1038/sc.2008.6. Epub 2008 Mar 4.
STUDY DESIGN
Retrospective clinical study with 1-year follow-up.
OBJECTIVES
Treatment of faecal incontinence by permanent sacral nerve stimulation (SNS) in patients suffering from cauda equina syndrome (CES).
SETTING
Klosterneuburg, Austria.
BACKGROUND AND PURPOSE
A flaccid paresis of the sphincter ani muscle and the pelvic floor combined with faecal incontinence can occur in patients suffering from CES as a result of a trauma in the region of the lumbar spine. If the incontinence cannot be managed by the use of laxatives or anal tampons, the patient is restricted in his/her quality of life. Thus, it was our aim to improve sphincter function and anal sensitivity to achieve voluntary rectal defaecation.
MATERIALS AND METHODS
The functional integrity of at least one sacral root (S2-S4) was determined through percutaneous nerve evaluation (PNE). Following this analysis, a period of external temporary SNS was performed to evaluate the functional effect. If there was a decrease in the number of episodes of faecal incontinence during this evaluation period, a neurostimulation device (InterStim; Medtronic) was implanted.
PATIENTS
A total of 11 patients suffering from flaccid paresis of the anal sphincter muscle and faecal incontinence caused by CES underwent PNE, which was successful in 8 patients. Two of these patients were eliminated from the procedure at the end of the temporary SNS period, one patient refused the permanent implantation. Therefore, five patients proceeded to permanent implantation, which led to an improved continence in all the cases.
DISCUSSION
In the synopsis of the preoperative proctologic and neurological findings, successful electric stimulation of the sacral roots can be expected in incomplete CES. In the case of flaccid paresis of the anal sphincter muscles caused by an incomplete CES, permanent SNS offers a promising option for the treatment of faecal incontinence. .
研究设计
为期1年随访的回顾性临床研究。
目的
对马尾综合征（CES）患者采用永久性骶神经刺激（SNS）治疗大便失禁。
地点
奥地利克洛斯特新堡。
背景与目的
由于腰椎区域创伤，CES患者可能出现肛门括约肌和盆底松弛性麻痹并伴有大便失禁。如果使用泻药或肛门栓剂无法控制失禁，患者的生活质量会受到限制。因此，我们的目标是改善括约肌功能和肛门敏感性，以实现自主直肠排便。
材料与方法
通过经皮神经评估（PNE）确定至少一条骶神经根（S2 - S4）的功能完整性。在此分析之后，进行一段时期的外部临时SNS以评估功能效果。如果在此评估期内大便失禁发作次数减少，则植入神经刺激装置（InterStim；美敦力公司）。
患者
共有11例因CES导致肛门括约肌松弛性麻痹和大便失禁的患者接受了PNE，其中8例成功。在临时SNS期结束时，这些患者中有2例被排除在该治疗过程之外，1例患者拒绝永久性植入。因此，5例患者进行了永久性植入，所有病例的控便能力均得到改善。
讨论
在术前直肠病学和神经学检查结果的综述中，不完全性CES有望成功进行骶神经根电刺激。对于由不完全性CES引起的肛门括约肌松弛性麻痹，永久性SNS为治疗大便失禁提供了一个有前景的选择。
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