The Sir Alan Parks Department of Physiology, St Mark's Hospital and Academic Institute, Harrow, UK.
Colorectal Dis. 2013 Nov;15(11):1406-9. doi: 10.1111/codi.12371.
Although effective in faecal incontinence (FI), sacral nerve stimulation (SNS) is expensive and requires two procedures. It carries a small risk of infection and electrode migration. Transcutaneous SNS is noninvasive and cheap. Two small studies have reported the results when applied to segments S3 but there is no information on its effectiveness when applied to the whole sacral area.
A pilot study was carried out of self-administered transcutaneous SNS given over a 4-week period for 12 h a day. A 2-week bowel diary was kept for the final 2 weeks and compared with baseline. Patients were assessed using the St Mark's Incontinence Score, a visual analogue scale assessing satisfaction with bowel habit, the Rockwood FI Quality of Life (QOL) score and SF-36 QOL score.
Of the 10 patients recruited, two achieved complete continence. There was a statistically significant reduction in the median (interquartile range) frequency of incontinent episodes per week from 9.5 (7.5) to 3 (7.38) (P = 0.03), and in the median frequency of defaecation per week from 25.5 (19.5) to 14.5 (14.9) (P = 0.007). There was a statistically significant improvement in the median ability to defer defaecation from 1 (1.25) to 4.5 (4.5) min (P = 0.02). There was also a statistically significant improvement in the St Marks Incontinence Score from 20 (5.25) to 14.5 (8.0) (P = 0.01) and in the bowel habit satisfaction visual analogue scale from 8.5 (20) to 45 (33) (P = 0.008). There was no change in the Rockwood FI QOL or SF-36 QOL scores. No complications were reported.
Transcutaneous SNS appears to be an effective and safe treatment for FI. Larger controlled studies are needed to explore this further.
尽管骶神经刺激（SNS）在治疗粪便失禁（FI）方面有效，但它价格昂贵，需要进行两次手术。它有感染和电极迁移的风险。经皮 SNS 是一种非侵入性且廉价的方法。两项小型研究报告了将其应用于 S3 节段的结果，但没有关于将其应用于整个骶骨区域的有效性的信息。
进行了一项试点研究，对 10 名患者进行了为期 4 周的每天 12 小时的自我管理经皮 SNS 治疗。在最后 2 周内，患者保留了 2 周的排便日记，并与基线进行比较。使用 St Mark 失禁评分、评估肠道习惯满意度的视觉模拟量表、Rockwood FI 生活质量（QOL）评分和 SF-36 QOL 评分对患者进行评估。
在招募的 10 名患者中，有 2 名患者完全恢复了正常排便。每周失禁发作的中位数（四分位距）从 9.5（7.5）减少到 3（7.38）（P=0.03），每周排便的中位数频率从 25.5（19.5）减少到 14.5（14.9）（P=0.007）。有统计学意义的是，能够延迟排便的中位数能力从 1（1.25）提高到 4.5（4.5）分钟（P=0.02）。St Marks 失禁评分也从 20（5.25）提高到 14.5（8.0）（P=0.01），肠道习惯满意度视觉模拟评分从 8.5（20）提高到 45（33）（P=0.008）。Rockwood FI QOL 或 SF-36 QOL 评分没有变化。没有报告并发症。
经皮 SNS 似乎是 FI 的一种有效且安全的治疗方法。需要进行更大规模的对照研究来进一步探索。
