Pakravan Faramarz, Helmes Christian
Coloproktologisches Zentrum Duesseldorf, Duesseldorf, Germany.
Dis Colon Rectum. 2015 Jan;58(1):109-14. doi: 10.1097/DCR.0000000000000263.
Fecal incontinence is a common, distressing condition with limited surgical options.
This study examines the results of magnetic sphincter augmentation in patients with severe fecal incontinence.
This was a single-center, prospective, nonrandomized investigation.
This study was conducted in a private colorectal practice.
The cohort included all of the patients implanted with magnetic sphincter augmentation between January 2012 and October 2013.
Magnetic sphincter augmentation was studied.
Adverse events, symptom severity, quality of life, bowel diary, and manometry data were collected.
Eighteen patients (15 women), with mean age of 69 years (range, 31-91 years), were implanted with magnetic sphincter augmentation. Follow-up ranged from 353 to 738 days. Previous treatment consisted of peripheral nerve evaluation test in 10 patients (56%), 2 patients (11%) with previous permanent sacral nerve stimulation, and 1 patient (6%) with previous implantation of an artificial bowel sphincter. Implantation was successful in 17 (94%) of 18 patients. Five patients (29%) had postoperative pain, and 5 patients (29%) had temporary swelling and erythema in both gluteal regions after the implantation. No devices were explanted during the follow-up. Cleveland Clinic Incontinence Score decreased from a mean of 17.5 (range, 14.0-20.0) to 7.3 (range, 0-12.0), and Fecal Incontinence Quality of Life scores improved in all of the domains. Bowel diary results showed that 76% of the patients with implants experienced a ≥50% reduction in the number of fecal incontinence episodes per week. Manometry at 6 months after implantation showed increased mean resting and squeeze pressures.
This study does not allow for comparison between surgical treatments and involves a limited number of patients.
Magnetic sphincter augmentation shows consistent results for the treatment of severe fecal incontinence in this patient group. The surgical procedure is straightforward as compared with other implantable devices. The safety profile is acceptable. Magnetic sphincter augmentation is a promising new treatment with the potential to become a first-line surgical therapy for patients with severe fecal incontinence.
大便失禁是一种常见且令人苦恼的病症，手术选择有限。
本研究探讨严重大便失禁患者行磁括约肌增强术的效果。
这是一项单中心、前瞻性、非随机研究。
本研究在一家私人结直肠诊所进行。
该队列包括2012年1月至2013年10月期间所有接受磁括约肌增强术的患者。
对磁括约肌增强术进行研究。
收集不良事件、症状严重程度、生活质量、排便日记及测压数据。
18例患者（15例女性）接受了磁括约肌增强术，平均年龄69岁（范围31 - 91岁）。随访时间为353至738天。既往治疗包括10例患者（56%）接受过周围神经评估测试，2例患者（11%）曾接受永久性骶神经刺激，1例患者（6%）曾植入人工肛门括约肌。18例患者中有17例（94%）植入成功。5例患者（29%）术后疼痛，5例患者（29%）植入后双侧臀部出现暂时性肿胀和红斑。随访期间无装置取出。克利夫兰诊所失禁评分从平均17.5（范围14.0 - 20.0）降至7.3（范围0 - 12.0），且所有领域的大便失禁生活质量评分均有所改善。排便日记结果显示，76%的植入患者每周大便失禁发作次数减少≥50%。植入后6个月测压显示静息和收缩压均值升高。
本研究无法对手术治疗进行比较，且患者数量有限。
磁括约肌增强术在该患者群体中治疗严重大便失禁显示出一致的效果。与其他可植入装置相比，该手术操作简单。安全性可接受。磁括约肌增强术是一种有前景的新治疗方法，有可能成为严重大便失禁患者的一线手术治疗方法。
