Department of Pelvic Floor and GI Physiology at University College London Hospital, London, United Kingdom.
Dis Colon Rectum. 2011 Sep;54(9):1134-40. doi: 10.1097/DCR.0b013e318220c0ba.
The indications for sacral nerve stimulation are increasing, but the mechanism remains poorly understood.
This study aimed to examine the effect of sacral nerve stimulation on rectal compliance and rectal sensory function.
This was a prospective study.
This study took place at a university teaching hospital.
Twenty-three consecutive consenting patients (22 female; median age, 49 y) undergoing temporary sacral nerve stimulation for fecal incontinence were prospectively studied. Clinical response was assessed by the use of bowel diaries and Wexner scores.
Anal manometry, rectal compliance, volume and pressure thresholds to rectal distension (barostat), and rectal Doppler mucosal blood flow were measured before and at the end of stimulation.
Sixteen patients (70%) had a favorable clinical response. Median anal squeeze pressures increased with stimulation from 40 (range, 6-156) cmH2O to 64 (range, 16-243) cmH2O. Median rectal compliance did not significantly change with stimulation (prestimulation: 11.5 (range, 7.9-21.8) mL/mmHg, poststimulation: 12.4 (range, 6.2-22) mL/mmHg, P = .941). Rectal wall pressures associated with urge (baseline: 15.4 (range, 11-26.7) mmHg, poststimulation: 19 (range, 11.1-42.7) mmHg, P = .054) and maximal tolerated thresholds (baseline: 21.6 (8.5-31.9) mmHg, poststimulation: 27.1 (14.3-43.3) mmHg, P = .023) significantly increased after stimulation. Rectal Doppler mucosal blood flow did not significantly change with stimulation (baseline: 125.8 (69.9-346.8), poststimulation: 112.4 (50.2-404.1), P = .735). Changes in anal resting pressure and rectal wall pressures with stimulation were evident only in responders; however, changes in anal squeeze pressures were evident in both responders and nonresponders.
The study reports results following short-term stimulation in a small but homogenous group of patients. A larger long-term study will follow.
Temporary sacral nerve stimulation does not change rectal compliance, but is associated with significant changes to the pressure thresholds of rectal distension. This, together with the observation that outcome is not related to sphincter integrity, supports the hypothesis of an afferent-mediated mechanism of action.
骶神经刺激的适应证正在增加，但机制仍知之甚少。
本研究旨在研究骶神经刺激对直肠顺应性和直肠感觉功能的影响。
这是一项前瞻性研究。
一所大学教学医院。
23 例连续同意接受骶神经刺激治疗粪便失禁的患者（22 例女性；中位年龄 49 岁）前瞻性研究。通过使用排便日记和 Wexner 评分评估临床反应。
在刺激前和刺激结束时测量肛门测压、直肠顺应性、直肠扩张容积和压力阈值（测压计）以及直肠多普勒黏膜血流。
16 例患者（70%）有良好的临床反应。刺激后平均肛门收缩压从 40cmH2O（范围 6-156cmH2O）增加至 64cmH2O（范围 16-243cmH2O）。刺激后直肠顺应性无显著变化（刺激前：11.5mL/mmHg（范围 7.9-21.8），刺激后：12.4mL/mmHg（范围 6.2-22），P=0.941）。与急迫感相关的直肠壁压力（基线：15.4mmHg（范围 11-26.7），刺激后：19mmHg（范围 11.1-42.7），P=0.054）和最大耐受阈值（基线：21.6mmHg（8.5-31.9），刺激后：27.1mmHg（14.3-43.3），P=0.023）在刺激后显著增加。直肠多普勒黏膜血流在刺激后无显著变化（基线：125.8（69.9-346.8），刺激后：112.4（50.2-404.1），P=0.735）。仅在有反应者中观察到刺激后肛门静息压和直肠壁压力的变化，而在有反应者和无反应者中均观察到肛门收缩压的变化。
本研究报告了短期刺激后小但同质患者组的结果。一项更大的长期研究将随后进行。
暂时的骶神经刺激不会改变直肠顺应性，但与直肠扩张的压力阈值显著变化有关。这与结局与括约肌完整性无关的观察结果一起，支持传入介导作用机制的假设。
