采用 3889 型电极和标准化植入技术，可改善骶神经刺激治疗粪便失禁的功能效果。

The functional outcome of sacral nerve stimulation for faecal incontinence can be improved by using lead model 3889 and a standardized implantation technique.

机构信息

Surgical Research Unit, Department of Surgery, Aarhus University Hospital, Aarhus C, Denmark.

出版信息

Colorectal Dis. 2018 Jun;20(6):O152-O157. doi: 10.1111/codi.14234. Epub 2018 May 16.

DOI:10.1111/codi.14234

PMID:29694697

Abstract

AIM

Sacral nerve stimulation has been recognized as an effective treatment option for faecal incontinence when conservative therapy has failed. Refinement of the procedural technique and the use of a curved stylet may improve the functional outcome. Our aim was to explore the relationship between lead model, functional outcome, stimulation amplitude and the need for extra visits during the first year of follow-up.

METHOD

Patient data from May 2009 to February 2017, which were prospectively collected in a local database, were extracted and analysed for differences between lead model and improvement in incontinence scores, stimulation amplitude and the need for additional visits during the first year of follow-up.

RESULTS

A foramen lead model 3093(straight stylet) was used in 134 patients and lead model 3889(curved stylet) was used in 40 patients. There were no differences in baseline characteristics or incontinence scores. Comparing results between the two lead models we found that the improvement (delta value) in the Wexner score at 6 months' follow-up (P = 0.05) and the St Mark's score at 12 months' follow-up (P = 0.02) was greater in patients implanted with lead model 3889(curved stylet) compared with patients implanted with lead model 3093(straight stylet). Patients implanted with lead model 3889 (curved stylet) were less likely to have to alter the stimulation amplitude or pole configuration during the first year of follow-up (P = 0.04). No difference was found for stimulation amplitude (P = 0.170) or the need for additional visits (P = 0.663).

CONCLUSION

Lead model 3889 (curved stylet) improves functional results compared with lead model 3093 (straight stylet) during the first year of follow-up. Lead model 3889 (curved stylet) reduces the need for reprogramming but has no influence on stimulation amplitude or the number of additional visits required.

摘要

目的

当保守治疗失败时，骶神经刺激已被认为是治疗粪便失禁的有效方法。手术技术的改进和使用弯曲的引导针可能会改善功能结果。我们的目的是探讨在随访的第一年中，导联模型、功能结果、刺激幅度和额外就诊次数之间的关系。

方法

从 2009 年 5 月至 2017 年 2 月，前瞻性地从本地数据库中提取并分析了患者数据，以研究导联模型与失禁评分改善、刺激幅度以及在随访的第一年中额外就诊次数之间的差异。

结果

134 例患者使用 3093 导联模型（直引导针），40 例患者使用 3889 导联模型（弯引导针）。两组患者的基线特征或失禁评分无差异。比较两种导联模型的结果发现，在 6 个月随访时的 Wexner 评分改善（P=0.05）和 12 个月随访时的 St Mark 评分改善（P=0.02），使用 3889 导联模型（弯引导针）的患者比使用 3093 导联模型（直引导针）的患者更大。在随访的第一年中，使用 3889 导联模型（弯引导针）的患者需要改变刺激幅度或极配置的可能性较小（P=0.04）。在刺激幅度（P=0.170）或额外就诊次数（P=0.663）方面没有差异。