影响临时骶神经刺激治疗大便失禁效果的因素。新型叉状电极的价值。

Factors affecting the outcome of temporary sacral nerve stimulation for faecal incontinence. The value of the new tined lead electrode.

机构信息

Department of Emergency and Organ Transplantation, General Surgery and Liver transplantation Units, University of Bari, Bari, Italy.

出版信息

Colorectal Dis. 2011 Feb;13(2):198-202. doi: 10.1111/j.1463-1318.2009.02088.x.

DOI:10.1111/j.1463-1318.2009.02088.x

PMID:19863601

Abstract

AIM

Sacral nerve stimulation (SNS) is an effective but expensive treatment for faecal incontinence. About 50% of the patients are unresponsive for unknown reasons, hence knowledge of any factors predictive of success would be highly desirable. The aim of this study was to analyse the potential factors associated with a successful outcome of the temporary test of electrostimulation.

METHOD

Eighty-five patients with faecal incontinence were tested for SNS. The cause was idiopathic in 45, iatrogenic or obstetric in 28, spinal lesion or neurological diseases in nine and anal malformation in three patients; 43 were tested with a unipolar electrode and 42 with a quadripolar electrode. The severity of faecal incontinence was evaluated using the American Medical System (AMS) score and Wexner's score.

RESULTS

A positive response was obtained in 45 patients (53%); 40 (47%) were implanted with a permanent pulse generator. Responders and nonresponders were comparable in age, duration of incontinence, anal manometry, pudendal nerve terminal motor latency and diabetes. Unipolar electrode test (PNE test) was able to elicit positive responses in 18 of 43 (42%) and the quadripolar in 27 of 42 patients (P < 0.001). Type of incontinence and gender did not affect the success rate. Patients with idiopathic incontinence had a significantly higher response rate (P =0.022). Multivariate regression analysis indicated use of a quadripolar electrode as the only independent variable predicting the success of SNS (OR = 5.58, P = 0.009).

CONCLUSION

Use of the quadripolar electrode is the only factor significantly related to the success of SNS.

摘要

目的

骶神经刺激（SNS）是治疗粪便失禁的一种有效但昂贵的方法。大约 50%的患者由于未知原因没有反应，因此了解任何预测成功的因素都是非常理想的。本研究旨在分析与电刺激临时测试成功结果相关的潜在因素。

方法

85 例粪便失禁患者接受 SNS 测试。45 例为特发性病因，28 例为医源性或产科病因，9 例为脊髓损伤或神经疾病病因，3 例为肛门畸形病因；43 例采用单极电极测试，42 例采用四极电极测试。粪便失禁的严重程度采用美国医学系统（AMS）评分和 Wexner 评分进行评估。

结果

45 例（53%）患者获得阳性反应；40 例（47%）植入永久性脉冲发生器。应答者和无应答者在年龄、失禁持续时间、肛门测压、阴部神经末端运动潜伏期和糖尿病方面无差异。单极电极测试（PNE 测试）在 43 例中能引起 18 例（42%）阳性反应，在 42 例中能引起 27 例（P < 0.001）。失禁类型和性别不影响成功率。特发性失禁患者的反应率显著更高（P =0.022）。多变量回归分析表明，使用四极电极是预测 SNS 成功的唯一独立变量（OR = 5.58，P = 0.009）。