Vallès Margarita, Rodríguez Alfred, Borau Albert, Mearin Fermín
Functional Digestive Rehabilitation Unit, Institut Guttmann (affiliated with the Autonomous University of Barcelona), Barcelona, Spain.
Dis Colon Rectum. 2009 May;52(5):986-92. doi: 10.1007/DCR.0b013e31819ed459.
Bowel dysfunction is a problem in patients with spinal cord injury. The sacral anterior root stimulator has been used for neurogenic bladder and has been claimed to be useful for neurogenic bowel. The purposes of this study were to analyze the clinical response of bowel function to the sacral anterior root stimulator and to evaluate physiologic factors that could determine its efficacy.
Eighteen consecutive patients with spinal cord injury and an implanted sacral anterior root stimulator were evaluated. Clinical assessment, colonic transit time, and anorectal manometry were performed. Patients were evaluated before implantation of the sacral anterior root stimulator and clinically reevaluated after 12 months.
Fewer patients required laxatives after implantation of the sacral anterior root stimulator. The mean number of methods used to evacuate was reduced from 2.1 to 1.5 (P < 0.05). Bowel movement frequency was higher (P < 0.05). Time devoted to defecation was reduced, although no statistical significance was achieved. Fecal incontinence did not change, but constipation was reduced (P < 0.05). Most patients reported being more satisfied with bowel function after implantation of the sacral anterior root stimulator. No correlation was found between objective and subjective responses to the sacral anterior root stimulator and manometric or colonic transit times before implantation.
The sacral anterior root stimulator improves bowel function, and patient satisfaction with this treatment is high. Further studies are needed to evaluate the characteristics of stimulation parameters to achieve better results.
肠道功能障碍是脊髓损伤患者面临的一个问题。骶前根刺激器已被用于神经源性膀胱，并且据称对神经源性肠道也有作用。本研究的目的是分析肠道功能对骶前根刺激器的临床反应，并评估可能决定其疗效的生理因素。
对18例连续的脊髓损伤且植入了骶前根刺激器的患者进行评估。进行了临床评估、结肠转运时间测定和肛门直肠测压。在植入骶前根刺激器前对患者进行评估，并在12个月后进行临床重新评估。
植入骶前根刺激器后需要泻药的患者减少。排便所用方法的平均数量从2.1种减少至1.5种（P<0.05）。排便频率更高（P<0.05）。用于排便的时间减少，尽管未达到统计学显著性。大便失禁没有变化，但便秘减轻（P<0.05）。大多数患者报告在植入骶前根刺激器后对肠道功能更满意。在对骶前根刺激器的客观和主观反应与植入前的测压或结肠转运时间之间未发现相关性。
骶前根刺激器可改善肠道功能，患者对这种治疗的满意度较高。需要进一步研究以评估刺激参数的特征以取得更好的结果。
