Rodrigues F G, Chadi S A, Cracco A J, Sands D R, Zutshi M, Gurland B, Da Silva G, Wexner S D
Cleveland Clinic Florida, Weston, Florida, USA.
National Council for Scientific and Technological Development (CNPq), Brasilia, Brazil.
Colorectal Dis. 2017 May;19(5):456-461. doi: 10.1111/codi.13510.
Sphincteroplasty (SP) is used to treat faecal incontinence (FI) in patients with a sphincter defect. Although sacral nerve stimulation (SNS) is used in patients, its outcome in patients with a sphincter defect has not been definitively evaluated. We compared the results of SP and SNS for FI associated with a sphincter defect.
Patients treated by SNS or SP for FI with an associated sphincter defect were retrospectively identified from an Institutional Review Board approved prospective database. Patients with ultrasound evidence of a sphincter defect were matched by age, gender and body mass index. The main outcome measure was change in the Cleveland Clinic Florida Faecal Incontinence Score (CCF-FIS).
Twenty-six female patients with a sphincter defect were included in the study. The 13 patients in each group were similar for age, body mass index, initial CCF-FIS and the duration of follow-up. No differences were observed in parity (P = 1.00), the rate of concomitant urinary incontinence (P = 0.62) or early postoperative complications. Within-group analysis showed a significant reduction of the CCF-FIS among patients having SNS (15.9-8.4; P = 0.003) but not SP (16.9-12.9; P = 0.078). There was a trend towards a more significant improvement in CCF-FIS in the SNS than in the SP group (post-treatment CCF-FIS 8.4 vs 12.9, P = 0.06). Net improvement in CCF-FIS was not significantly different between the groups (P = 0.06).
Significant improvement in CCF-FIS was observed in patients treated with SNS but not SP patients. A trend towards better results was seen with SNS.
括约肌成形术（SP）用于治疗存在括约肌缺陷的大便失禁（FI）患者。尽管骶神经刺激（SNS）也应用于此类患者，但其在括约肌缺陷患者中的疗效尚未得到明确评估。我们比较了SP和SNS治疗与括约肌缺陷相关的FI的结果。
从机构审查委员会批准的前瞻性数据库中回顾性确定接受SNS或SP治疗的伴有括约肌缺陷的FI患者。有括约肌缺陷超声证据的患者按年龄、性别和体重指数进行匹配。主要结局指标是克利夫兰诊所佛罗里达大便失禁评分（CCF-FIS）的变化。
26例有括约肌缺陷的女性患者纳入研究。每组13例患者在年龄、体重指数、初始CCF-FIS和随访时间方面相似。在产次（P = 1.00）、并发尿失禁率（P = 0.62）或术后早期并发症方面未观察到差异。组内分析显示，接受SNS治疗的患者CCF-FIS显著降低（15.9 - 8.4；P = 0.003），而接受SP治疗的患者未降低（16.9 - 12.9；P = 0.078）。SNS组CCF-FIS的改善趋势比SP组更显著（治疗后CCF-FIS为8.4对12.9，P = 0.06）。两组间CCF-FIS的净改善无显著差异（P = 0.06）。
接受SNS治疗的患者CCF-FIS有显著改善，而接受SP治疗的患者未改善。SNS有取得更好结果的趋势。
