通过刺激骶前神经根控制脊髓损伤患者的排便
Control of defecation in patients with spinal injuries by stimulation of sacral anterior nerve roots.
作者信息
MacDonagh R P, Sun W M, Smallwood R, Forster D, Read N W
机构信息
Spinal Injuries Unit, Lodge Moor Hospital, Sheffield.
出版信息
BMJ. 1990 Jun 9;300(6738):1494-7. doi: 10.1136/bmj.300.6738.1494.
OBJECTIVE
To observe the effects of stimulation of the sacral anterior roots on anorectal and low colonic pressures and to programme implanted stimulators to produce defecation.
DESIGN
Prospective study of 12 consecutive patients.
SETTING
Spinal injuries unit and university gastrointestinal physiology department.
PATIENTS
12 Patients with complete supraconal spinal cord lesions. Their injuries had been sustained at least two years before the study.
INTERVENTIONS
A Brindley-Finetech intradural sacral anterior root stimulator was implanted in all patients. Three months postoperatively the stimulator settings were adjusted after measurement of simultaneous anorectal and low colonic pressures.
MAIN OUTCOME MEASURES
Full defecation.
RESULTS
Six patients achieved complete rectal evacuation of faeces using the implant and subsequently did not require manual help for defecation. For all but one of the patients the total time taken to complete defecation was reduced, and all were free from constipation, the most prevalent gastrointestinal symptom in patients with spinal injuries.
CONCLUSIONS
Sacral anterior root stimulators can be programmed to achieve complete unassisted defecation and can considerably improve the quality of life of patients with spinal injuries.
目的
观察刺激骶前神经根对肛门直肠和低位结肠压力的影响，并对植入式刺激器进行编程以引发排便。
设计
对12例连续患者进行的前瞻性研究。
地点
脊髓损伤病房和大学胃肠生理学系。
患者
12例圆锥以上脊髓完全损伤患者。他们的损伤发生在研究前至少两年。
干预措施
所有患者均植入Brindley-Finetech硬膜内骶前神经根刺激器。术后三个月，在同时测量肛门直肠和低位结肠压力后调整刺激器设置。
主要观察指标
完全排便。
结果
6例患者使用植入装置实现了直肠完全排空粪便，随后排便无需人工协助。除1例患者外，所有患者完成排便的总时间均缩短，且均无便秘，便秘是脊髓损伤患者中最常见的胃肠道症状。
结论
骶前神经根刺激器可以进行编程以实现完全自主排便，并可显著改善脊髓损伤患者的生活质量。
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