Physiology Unit, St Mark's Hospital, Harrow, UK.
Colorectal Dis. 2011 Aug;13(8):e187-95. doi: 10.1111/j.1463-1318.2011.02650.x.
Faecal incontinence is estimated to affect between 2 and 3% of Western adult populations. In recent years sacral nerve stimulation has become an important treatment modality, often as the first-line surgical therapy. The aim of this article was to review the current evidence regarding patient selection and surgical technique and to evaluate the logistics of providing a neurostimulation service.
A Medline search was performed including the keywords and/or MeSH headings of sacral nerve stimulation, neuromodulation, artificial pacemaker, faecal incontinence, patient selection, predictive factors and anal canal. Further studies were identified by cross-referencing from relevant articles and by appraisal of recent peer-reviewed conference abstracts and proceedings.
Despite the success of sacral nerve stimulation for several pathophysiological causes of incontinence, case selection is of paramount importance. Sacral nerve stimulation should not be offered outside a multidisciplinary pelvic floor unit. Temporary evaluation using diary cards can lead to false positive and negative results. Adherence to a meticulous surgical technique, using low amplitude stimulation to guide lead placement, provides optimal clinical outcome.
The short-term outcome of sacral nerve stimulation is dependent on patient factors and operative technique. Despite this, specific preoperative predictive factors of treatment success have yet to be identified.
据估计，粪便失禁影响着 2%至 3%的西方成年人。近年来，骶神经刺激已成为一种重要的治疗方式，通常作为一线手术治疗。本文旨在回顾目前关于患者选择和手术技术的证据，并评估提供神经刺激服务的后勤工作。
对 Medline 进行了检索，包括骶神经刺激、神经调节、人工起搏器、粪便失禁、患者选择、预测因素和肛门直肠等关键词和/或 MeSH 标题。通过交叉引用相关文章以及评估最近的同行评审会议摘要和会议记录，确定了进一步的研究。
尽管骶神经刺激对几种失禁的病理生理原因都取得了成功，但病例选择至关重要。骶神经刺激不应在多学科盆底单位之外提供。使用日记卡进行临时评估可能会导致假阳性和假阴性结果。采用低幅度刺激引导导丝放置的精细手术技术可提供最佳的临床效果。
骶神经刺激的短期疗效取决于患者因素和手术技术。尽管如此，特定的术前治疗成功预测因素尚未确定。
