Department of Surgery, Campus Benjamin Franklin, Charité-University Medicine Berlin, Hindenburgdamm 30, 12203 Berlin, Germany.
J Gastrointest Surg. 2010 Apr;14(4):636-44. doi: 10.1007/s11605-009-1122-1.
Sacral nerve stimulation (SNS) can improve fecal incontinence, though the exact mechanism is not known. This study examines the following hypotheses: SNS leads to contraction of the pelvic floor, influences rectal perception, and improves continence and quality of life.
Fourteen patients with sacral nerve stimulators implanted for fecal incontinence were examined prospectively. Morphological and functional assessment was done by endosonography, manometry, and volumetry with the stimulator turned on and off in direct succession. Questionnaires were used to determine incontinence and quality of life.
With the stimulator turned on, rectal filling conditions were perceived only at higher volumes; in particular, the defecation urge was sensed only at higher volumes. There was also a reduction in the diameters of the external and internal anal sphincters and a decrease in the distance between the anal mucosa and the symphysis as a sign of pelvic floor elevation. Six months after surgery, continence and quality of life were markedly better than before the operation.
We were able to confirm the hypotheses given above. The improvements of pelvic floor contraction and rectal perception are rapid adjustment processes in response to stimulation of sacral nerves S3/S4 when turning on the stimulator.
骶神经刺激（SNS）可改善粪便失禁，但确切机制尚不清楚。本研究检验了以下假设：SNS 可引起盆底收缩，影响直肠感觉，并改善控便能力和生活质量。
前瞻性检查 14 例因粪便失禁植入骶神经刺激器的患者。通过内镜超声、测压和容积测量进行形态和功能评估，刺激器依次开启和关闭。采用问卷调查评估失禁和生活质量。
刺激器开启时，仅在更高的容积下才能感知直肠充盈状态；特别是，仅在更高的容积下才能感知到排便紧迫感。此外，还观察到外括约肌和内括约肌直径减小，以及肛黏膜与坐骨之间距离减小，提示盆底抬高。术后 6 个月，控便能力和生活质量明显优于术前。
我们能够证实上述假设。刺激器开启时对 S3/S4 骶神经的刺激会迅速引起盆底收缩和直肠感觉的改善，这是一种快速的调整过程。
