Pelvic Floor Unit, I Department of Surgery, Regional Hospital, Treviso, Italy.
Dis Colon Rectum. 2012 Jul;55(7):797-805. doi: 10.1097/DCR.0b013e3182538f14.
Atrophy of the external anal sphincter, a pathologic muscle volume anomaly associated with fecal incontinence, has been shown to be a negative predictor of the outcome of surgery for defects of the external anal sphincter. It is unclear whether external anal sphincter atrophy also affects the outcome of sacral nerve stimulation for fecal incontinence.
Our aim was to assess the effectiveness of sacral nerve stimulation in patients with fecal incontinence and external anal sphincter atrophy and to determine whether severity of atrophy and concomitant presence of a sphincter defect are negative predictors of outcome.
This was a prospective observational study of treatment outcome.
The study was conducted from November 2004 through November 2010 at a regional hospital in Italy.
Consecutive patients with fecal incontinence and external anal sphincter atrophy were included. By means of MRI, patients were determined to have either moderate (<50%) or severe (≥ 50%) thinning of and/or replacement of sphincter muscle by fat. The concomitant presence of defects of the external anal sphincter was also detected by MRI.
All patients underwent sacral nerve stimulation through a staged implantation procedure.
The main outcome measures were improvement in the Cleveland Clinic Florida Fecal Incontinence Scale (Wexner score), number of episodes of incontinence per week, and the Fecal Incontinence Quality of Life Scale.
A total of 28 patients underwent definitive implantation of the sacral nerve stimulation device. Wexner scores decreased from a median of 16 (range, 10-20) at baseline to 3 (range, 0-8) at 6-month follow-up (p < 0.001). Weekly incontinence episodes decreased from a mean (SD) of 14.7 (12.5) to 0.40 (0.82); p < 0.001. Improvement was significantly related to severity of fecal incontinence (r = 0.86; p < 0.001). Overall quality-of-life scores improved from a mean of 1.8 (0.6) to 3.8 (0.4);p < 0.001. Sacral nerve stimulation was effective in both moderate (n = 16) and severe (n = 12) atrophy and in patients with (n = 8) or without (n = 20) external anal sphincter defects.
The study was limited by its observational nature and relatively small sample size.
Sacral nerve stimulation can be effective in restoring continence and improving quality of life in patients with fecal incontinence related to atrophy of the external anal sphincter, regardless of the severity of atrophy. Moreover, the presence of EAS atrophy does not influence the success of the outcome of SNS in patients with a sphincter defect. These findings are consistent with the hypothesis that the effects of SNS are not achieved solely by its action on the anal sphincter complex.
肛门外括约肌萎缩是一种与粪便失禁相关的病理性肌肉体积异常，已被证明是肛门外括约肌缺陷手术结果的负性预测因子。目前尚不清楚肛门外括约肌萎缩是否也会影响骶神经刺激治疗粪便失禁的效果。
我们旨在评估骶神经刺激治疗粪便失禁伴肛门外括约肌萎缩患者的效果，并确定萎缩的严重程度和同时存在的括约肌缺陷是否是结果的负性预测因子。
这是一项治疗效果的前瞻性观察性研究。
该研究于 2004 年 11 月至 2010 年 11 月在意大利的一家地区医院进行。
连续纳入患有粪便失禁和肛门外括约肌萎缩的患者。通过 MRI，患者被确定为肛门外括约肌的厚度有中度（<50%）或重度（≥50%）变薄和/或脂肪替代。MRI 还检测到肛门外括约肌的同时存在缺陷。
所有患者均通过分期植入手术接受骶神经刺激。
主要观察指标为克利夫兰诊所佛罗里达粪便失禁评分（Wexner 评分）、每周失禁次数和粪便失禁生活质量评分的改善情况。
共有 28 例患者接受了骶神经刺激装置的确定性植入。Wexner 评分从基线时的中位数 16 分（范围 10-20 分）降至 6 个月随访时的 3 分（范围 0-8 分）（p < 0.001）。每周失禁次数从平均（标准差）14.7（12.5）次降至 0.40（0.82）次；p < 0.001。改善与粪便失禁的严重程度显著相关（r = 0.86；p < 0.001）。总体生活质量评分从平均 1.8（0.6）分提高到 3.8（0.4）分；p < 0.001。骶神经刺激对中度（n = 16）和重度（n = 12）萎缩以及有（n = 8）或无（n = 20）肛门外括约肌缺陷的患者均有效。
该研究受到其观察性质和相对较小的样本量的限制。
骶神经刺激可以有效恢复肛门外括约肌萎缩相关的粪便失禁患者的控便能力并改善生活质量，无论萎缩的严重程度如何。此外，EAS 萎缩的存在并不影响 SNS 治疗有括约肌缺陷患者的结果成功率。这些发现与 SNS 的作用不仅通过其对肛门括约肌复合体的作用来实现的假设一致。
