Department of Anorectal Physiology, St George Hospital, Sydney, Australia.
Br J Surg. 2013 Jun;100(7):959-68. doi: 10.1002/bjs.9114. Epub 2013 Mar 27.
Sacral nerve stimulation (SNS) is an effective treatment for neurogenic faecal incontinence (FI). However, the clinical improvement that patients experience cannot be explained adequately by changes in anorectal function. The aim of this study was to examine the effect of SNS on colonic propagating sequences (PSs) in patients with FI in whom urgency and incontinence was the predominant symptom.
In patients with FI a high-resolution fibre-optic manometry catheter, containing 90 sensors spaced at 1-cm intervals, was positioned colonoscopically and clipped to the caecum. A unipolar or quadripolar tined electrode was implanted into the S3 sacral nerve foramen. Colonic manometry was evaluated in a double-blind randomized crossover trial, using true suprasensory stimulation or sham stimulation. Each stimulation period, lasting 2 h, was preceded by a 2-h basal manometric recording.
All 11 patients studied showed a colonic response to SNS. In ten patients there was a significant increase in the frequency of retrograde PSs throughout the colon during true stimulation compared with sham stimulation (P = 0·014). In one outlier, with baseline retrograde PS frequency nine times that of the nearest patient, a reduction in retrograde PS frequency was recorded. Compared with sham stimulation, SNS had no effect on the frequency of antegrade PSs or high-amplitude PSs.
SNS modulates colonic motility in patients with faecal urge incontinence. These data suggest that SNS may improve continence and urgency through alteration of colonic motility, particularly by increasing retrograde PSs in the left colon.
骶神经刺激（SNS）是治疗神经性大便失禁（FI）的有效方法。然而，患者所经历的临床改善不能充分解释为肛肠功能的变化。本研究的目的是研究 SNS 对以急迫和失禁为主要症状的 FI 患者结肠传播序列（PS）的影响。
在 FI 患者中，通过结肠镜定位并夹在盲肠上的高分辨率光纤测压导管，其中包含 90 个传感器，间隔 1 厘米。将单极或四极叉形电极植入 S3 骶神经孔。在双盲随机交叉试验中，使用真正的超感觉刺激或假刺激评估结肠测压。每个刺激期持续 2 小时，之前进行 2 小时的基础测压记录。
所有 11 名研究患者均对 SNS 有结肠反应。在 10 名患者中，与假刺激相比，真正刺激时整个结肠逆行 PS 的频率显著增加（P = 0.014）。在一个离群值患者中，基线逆行 PS 频率是最近患者的九倍，记录到逆行 PS 频率降低。与假刺激相比，SNS 对顺行 PS 或高振幅 PS 的频率没有影响。
SNS 调节 FI 患者的结肠运动。这些数据表明，SNS 通过改变结肠运动，特别是通过增加左结肠的逆行 PS，可能改善失禁和急迫感。
