Simillis Constantinos, Lal Nikhil, Qiu Shengyang, Kontovounisios Christos, Rasheed Shahnawaz, Tan Emile, Tekkis Paris P
Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Fulham Road, London, UK.
Department of Surgery and Cancer, Imperial College, London, UK.
Int J Colorectal Dis. 2018 May;33(5):645-648. doi: 10.1007/s00384-018-2976-z. Epub 2018 Feb 22.
Percutaneous tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS) are both second-line treatments for faecal incontinence (FI). To compare the clinical outcomes and effectiveness of SNS versus PTNS for treating FI in adults.
A literature search of MEDLINE, Embase, Science Citation Index Expanded and Cochrane was performed in order to identify studies comparing SNS and PTNS for treating FI. A risk of bias assessment was performed using The Cochrane Collaboration's risk of bias tool. A random effects model was used for the meta-analysis.
Four studies (one randomised controlled trial and three nonrandomised prospective studies) reported on 302 patients: 109 underwent SNS and 193 underwent PTNS. All included studies noted an improvement in symptoms after treatment, without any significant difference in efficacy between SNS and PTNS. Meta-analysis demonstrated that the Wexner score improved significantly with SNS compared to PTNS (weighted mean difference 2.27; 95% confidence interval 3.42, 1.12; P < 0.01). Moreover, SNS was also associated with a significant reduction in FI episodes per week and a greater improvement in the Fecal Incontinence Quality of Life coping and depression domains, compared to PTNS on short-term follow-up. Only two studies reported on adverse events, reporting no serious adverse events with neither SNS nor PTNS.
Current evidence suggests that SNS results in significantly improved functional outcomes and quality of life compared to PTNS. No serious adverse events were identified with either treatment. Further, high-quality, multi-centre randomised controlled trials with standardised outcome measures and long-term follow-up are required in this field.
经皮胫神经刺激（PTNS）和骶神经刺激（SNS）均为大便失禁（FI）的二线治疗方法。比较SNS与PTNS治疗成人FI的临床疗效。
检索MEDLINE、Embase、科学引文索引扩展版和Cochrane数据库，以确定比较SNS和PTNS治疗FI的研究。使用Cochrane协作网的偏倚风险工具进行偏倚风险评估。采用随机效应模型进行荟萃分析。
四项研究（一项随机对照试验和三项非随机前瞻性研究）报告了302例患者：109例行SNS，193例行PTNS。所有纳入研究均指出治疗后症状有所改善，SNS和PTNS在疗效上无显著差异。荟萃分析表明，与PTNS相比，SNS治疗后Wexner评分显著改善（加权平均差2.27；95%置信区间3.42, 1.12；P < 0.01）。此外，在短期随访中，与PTNS相比，SNS还与每周FI发作次数显著减少以及大便失禁生活质量应对和抑郁领域的更大改善相关。只有两项研究报告了不良事件，均未报告SNS和PTNS有严重不良事件。
目前的证据表明，与PTNS相比，SNS能显著改善功能结局和生活质量。两种治疗方法均未发现严重不良事件。此外，该领域需要开展高质量、多中心、采用标准化结局指标并进行长期随访的随机对照试验。
