经阴道入路植入人工肛门括约肌治疗严重大便失禁：一家机构治疗的 32 例患者的经验。

Artificial anal sphincter for severe fecal incontinence implanted by a transvaginal approach: experience with 32 patients treated at one institution.

机构信息

Department of Digestive Surgery, Rouen University Hospital, Rouen, France.

出版信息

Dis Colon Rectum. 2010 Aug;53(8):1155-60. doi: 10.1007/DCR.0b013e3181e19d68.

DOI:10.1007/DCR.0b013e3181e19d68

PMID:20628279

Abstract

PURPOSE

Our aim was to evaluate medium-term results of transvaginal implantation of an artificial anal sphincter in a large series of patients.

METHODS

Women undergoing treatment for severe fecal incontinence at Rouen University Hospital, Rouen, France, from January 2003 through December 2007 were eligible for the study if the fecal incontinence had lasted for 6 months and if they had attempted other therapies without success. All patients received implantation of an artificial anal sphincter via a transvaginal approach. Incontinence was assessed with the Cleveland Clinic Florida Fecal Incontinence Scale (Wexner score).

RESULTS

A total of 32 women entered the study. Their median age was 63 (range, 26-79) years. At entry, 20 (63%) had severe destruction and scarring of the perineum, which was a contraindication for implantation via a perineal approach. Nine patients (28.1%) had previously undergone implantation of an AAS which had been removed because of complications, and 5 had had a Pickrell procedure for anal agenesia. No deaths occurred during the study. The device was removed in a total of 9 patients (28.1%): in 7 because of septic adverse events within the first 6 months after the operation, in 1 because of poor function, and in 1 for psychological reasons despite good functional results. Implantation was successful in 23 patients (71.9%), and the device remained activated for a mean follow-up of 41 (range, 18-75) months, with a mean decrease in Cleveland Clinic incontinence score from 18.4 to 6.8 (P < .0001). None of the patients complained of dyspareunia.

CONCLUSIONS

The transvaginal approach for implantation of an artificial anal sphincter permits treatment of women with fecal incontinence who have severe damage and scarring of the anterior perineum. This route provides an alternative for patients whose only therapeutic option would previously have been a defunctioning stoma.

摘要

目的

我们旨在评估经阴道植入人工肛门括约肌在一系列大量患者中的中期结果。

方法

2003 年 1 月至 2007 年 12 月期间，法国鲁昂大学医院对患有严重粪便失禁的女性进行了治疗，如果粪便失禁持续了 6 个月并且她们已经尝试了其他治疗但没有成功，则符合研究条件。所有患者均通过经阴道入路接受人工肛门括约肌植入。采用克利夫兰诊所佛罗里达粪便失禁量表（Wexner 评分）评估失禁。

结果

共有 32 名女性进入研究。她们的中位年龄为 63 岁（范围，26-79 岁）。入组时，20 名（63%）患者存在会阴严重破坏和瘢痕形成，这是经会阴入路植入的禁忌证。9 名患者（28.1%）之前曾植入过 AAS，因并发症而取出，5 名患者因肛门发育不全而行 Pickrell 手术。研究期间无死亡病例。共有 9 名患者（28.1%）取出了该设备：7 名患者因术后 6 个月内发生感染性不良事件，1 名患者因功能不良，1 名患者因功能良好但心理原因。23 名患者（71.9%）的植入获得成功，该设备的激活时间平均为 41 个月（范围，18-75 个月），克利夫兰诊所失禁评分从 18.4 分降至 6.8 分（P <.0001）。没有患者抱怨性交困难。