Michelsen H B, Christensen P, Krogh K, Rosenkilde M, Buntzen S, Theil J, Laurberg S
Surgical Research Unit, Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.
Br J Surg. 2008 Jun;95(6):779-84. doi: 10.1002/bjs.6083.
Sacral nerve stimulation reduces the frequency of defaecation in patients with faecal incontinence. The aim of this study was to examine the mechanism behind the reduced number of bowel movements in incontinent patients treated with sacral nerve stimulation.
The study included 20 patients with faecal incontinence and a positive percutaneous nerve evaluation test: 19 women and one man, with a median age of 63 (range 28-78) years. Colorectal scintigraphy was performed to assess colorectal emptying at defaecation before and after implantation. Segmental colorectal transit times were determined using radio-opaque markers.
The median frequency of defaecation per 3 weeks decreased from 56 (range 19-136) to 26 (range 12-78) (P < 0.002). At defaecation, antegrade transport from the ascending colon decreased from a median score of 8 (range 0-23) to 0 (range 0-11) per cent (P = 0.001), while retrograde transport from the descending colon increased from a median score of 0 (range 0-14) to 2 (range 0-30) per cent (P = 0.039). The median defaecation score was unchanged. There was a non-significant increase in median total gastrointestinal transit time from 2.5 (range 0.9-6.2) to 3.3 (range 0.8-6.2) days (P = 0.079).
Sacral nerve stimulation reduces antegrade transport from the ascending colon and increases retrograde transport from the descending colon at defaecation. This may prolong colonic transit time and increase the storage capacity of the colon.
骶神经刺激可降低大便失禁患者的排便频率。本研究旨在探讨骶神经刺激治疗失禁患者排便次数减少背后的机制。
本研究纳入20例大便失禁且经皮神经评估试验呈阳性的患者：19名女性和1名男性，中位年龄63岁（范围28 - 78岁）。在植入前后进行结肠闪烁扫描以评估排便时的结肠排空情况。使用不透X线标记物测定结肠节段转运时间。
每3周的排便中位频率从56次（范围19 - 136次）降至26次（范围12 - 78次）（P < 0.002）。排便时，升结肠的顺行转运从中位评分8%（范围0 - 23%）降至0%（范围0 - 11%）（P = 0.001），而降结肠的逆行转运从中位评分0%（范围0 - 14%）增至2%（范围0 - 30%）（P = 0.039）。排便中位评分未改变。总胃肠道转运时间中位数从2.5天（范围0.9 - 6.2天）增至3.3天（范围0.8 - 6.2天），差异无统计学意义（P = 0.079）。
骶神经刺激可减少排便时升结肠的顺行转运并增加降结肠的逆行转运。这可能会延长结肠转运时间并增加结肠的储存容量。
