ADEN EA4311/IFRMP 23, Physiology Unit, Rouen University Hospital, Rouen, France.
Eur J Phys Rehabil Med. 2011 Dec;47(4):661-76.
There are several modalities for treating neurogenic bowel dysfunction (NBD), including conservative treatments (diet, medications, biofeedback, transanal irrigation, massage, electrical stimulation, anal plug). When conservative treatments fail, clinicians can choose from a variety of therapeutic options, including colostomies, Malone anterograde continence enemas, sacral anterior root stimulator implantations, graciloplasties, and artificial bowel sphincters. We reviewed the various treatments for constipation and/or fecal incontinence in patients with NBD and propose over-reaching stepwise algorithms for the management of NBD. Our review included English language articles, randomized controlled studies, cohort studies, case-control studies, and retrospective studies (if necessary) that assessed the management of NBD. Our literature search identified 577 articles, of which 79 met our inclusion criteria. There is little evidence for the success of conservative but non-pharmacological treatments. There is strong evidence for the success of pharmacological interventions (i.e., prokinetic agents) in the treatment of chronic constipation. While surgical interventions may be considered, there is little evidence of their effectiveness. Bowel management programs for patients with neurologic diseases require a multi-faceted approach. While a range of medical and surgical treatments are available, there is little evidence for their effectiveness, with the exception of pharmacological interventions.
有几种治疗神经源性肠道功能障碍（NBD）的方法，包括保守治疗（饮食、药物、生物反馈、经肛门灌洗、按摩、电刺激、肛门塞）。当保守治疗失败时，临床医生可以选择多种治疗选择，包括结肠造口术、马龙前向持续性灌肠、骶前神经根刺激器植入、臀肌成形术和人工肛门括约肌。我们回顾了 NBD 患者便秘和/或粪便失禁的各种治疗方法，并提出了 NBD 管理的全面逐步算法。我们的综述包括评估 NBD 管理的英语文章、随机对照研究、队列研究、病例对照研究和回顾性研究（如有必要）。我们的文献检索确定了 577 篇文章，其中 79 篇符合我们的纳入标准。保守但非药物治疗成功的证据很少。药物干预（即促动力药物）在治疗慢性便秘方面有很强的证据支持。虽然可以考虑手术干预，但它们的有效性证据很少。神经疾病患者的肠道管理方案需要多方面的方法。虽然有多种医疗和手术治疗方法，但除了药物干预外，这些方法的有效性证据很少。
