Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
World J Surg. 2010 May;34(5):1109-14. doi: 10.1007/s00268-010-0474-8.
In the past decade numerous studies have been published on the successful treatment of fecal incontinence with sacral neuromodulation (SNM). The underlying mechanism of action for lower bowel motility disorders has been unclear. In the present study, the effect of SNM on the rectoanal angle in patients with fecal incontinence was investigated.
In 12 consecutive patients who qualified for SNM an X-defecography study was performed before SNM and at 6 months after permanent implant. Three single lateral rectal views were taken: one during rest, one during squeeze, and one during Valsalva's maneuver, after which the patient was asked to evacuate as rapidly and completely as possible during lateral fluoroscopy. At 6 months two further defecography studies were performed, one during stimulation with the pacemaker on and one with the pacemaker off.
The defecography studies showed that the rectoanal angle decreased during rest, squeeze, and Valsalva's maneuver. A slight increase in rectoanal angle was seen during defecation. However, the differences did not reach statistical significance. Sacral neuromodulation improved fecal continence significantly in all patients at 6 months. Median incontinence episodes per week decreased from 6.2 to 1.0 (P = 0.001), and incontinent days per week decreased from 3.7 to 1.0 (P = 0.001) with SNM. There were no significant changes in the median resting and squeeze anal canal pressures, 46.5 versus 49.7 mmHg and 67.1 versus 72.3 mmHg, respectively. Median stimulation amplitude at follow-up was 2.7 V (range: 0.9-5.3 V).
Rectoanal angle did not decrease significantly in patients with fecal incontinence during SNM.
在过去的十年中，已经有许多研究发表了关于骶神经调节（SNM）治疗粪便失禁的成功治疗。下肠运动障碍的作用机制尚不清楚。在本研究中，研究了 SNM 对粪便失禁患者直肠肛门角的影响。
在 12 名符合 SNM 条件的连续患者中，在 SNM 前和永久植入后 6 个月进行了 X 排便造影研究。进行了三次单独的直肠侧位检查：一次在休息时，一次在挤压时，一次在瓦尔萨尔瓦动作时，然后让患者在侧位透视下尽可能快速和完全排空。在 6 个月时进行了另外两次排便造影研究，一次在起搏器开启时进行，一次在起搏器关闭时进行。
排便造影研究显示，直肠肛门角在休息、挤压和瓦尔萨尔瓦动作时减小。在排便过程中，直肠肛门角略有增加。然而，这些差异没有达到统计学意义。在所有患者中，SNM 在 6 个月时显著改善了粪便节制。每周失禁发作次数中位数从 6.2 次减少到 1.0 次（P=0.001），每周失禁天数中位数从 3.7 天减少到 1.0 天（P=0.001）。SNM 前后的中位静息和挤压肛管压力分别为 46.5mmHg 和 67.1mmHg，分别为 49.7mmHg 和 72.3mmHg。随访时的中位刺激幅度为 2.7V（范围：0.9-5.3V）。
在 SNM 期间，粪便失禁患者的直肠肛门角没有明显下降。
