骶骨畸形患者粪便失禁的骶神经刺激治疗
Sacral nerve stimulation for faecal incontinence in patients with sacral malformation.
作者信息
Brunner M, Cui Z, Matzel K E
机构信息
Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
Department of Gastrointestinal Surgery, Coloproctology Section, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 145 Shandong Road, Shanghai, China.
出版信息
Int J Colorectal Dis. 2017 Jun;32(6):929-931. doi: 10.1007/s00384-016-2748-6. Epub 2016 Dec 30.
INTRODUCTION
Sacral nerve stimulation (SNS) is a common and effective treatment for faecal incontinence (FI), but accessibility of the sacral nerves is mandatory. In some cases, electrode placement fails for unknown reasons. A frequent cause could be sacral malformations, which have a high incidence (up to 24.1%) and can be unsuspected.
METHODS AND RESULTS
We report two patients with FI consequent to congenital anorectal malformation and associated sacral malformation. Despite partial sacral agenesis, SNS was feasible in both. They benefitted greatly from SNS, with an improved ability to postpone the urge up to at least 15 min, reduced incontinence episodes (at least 50%), and significantly better quality of life.
CONCLUSION
SNS may be feasible in patients with FI, even in the presence of sacral malformation. However, clinicians should be aware of the attendant technical difficulties. Preoperative imaging, preferably with MRI of the sacrum, is advisable. If the sacral spinal nerves are inaccessible technically, pudendal nerve stimulation could be considered, if anatomy permits.
引言
骶神经刺激（SNS）是治疗大便失禁（FI）的一种常见且有效的方法，但必须能够触及骶神经。在某些情况下，电极放置会因不明原因失败。一个常见原因可能是骶骨畸形，其发生率很高（高达24.1%）且可能未被察觉。
方法与结果
我们报告了两名因先天性肛门直肠畸形及相关骶骨畸形导致大便失禁的患者。尽管存在部分骶骨发育不全，但两名患者的骶神经刺激均可行。他们从骶神经刺激中受益匪浅，推迟排便冲动的能力提高至至少15分钟，失禁发作次数减少（至少50%），生活质量显著改善。
结论
即使存在骶骨畸形，骶神经刺激在大便失禁患者中也可能可行。然而，临床医生应意识到随之而来的技术困难。术前成像，最好是骶骨的磁共振成像，是可取的。如果从技术上无法触及骶脊神经，在解剖结构允许的情况下，可以考虑阴部神经刺激。
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