Widmann Bernhard, Galata Christian, Warschkow Rene, Beutner Ulrich, Ögredici Önder, Hetzer Franc H, Schmied Bruno M, Post Stefan, Marti Lukas
Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, Switzerland.
Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
J Neurogastroenterol Motil. 2019 Jan 31;25(1):159-170. doi: 10.5056/jnm17106.
BACKGROUND/AIMS: The aim of this study was to evaluate the sustainability of sacral neuromodulation (SNM) success in patients with fecal incontinence (FI) and/or constipation.
This is a retrospective analysis of a prospective database of patients who received SNM therapy for FI and/or constipation between 2006 and 2015. Success rates, complications and reintervention rates were assessed after up to 10 years of follow-up.
Electrodes for test stimulation were implanted in 101 patients, of whom 79 (78.2%) received permanent stimulation. The mean follow-up was 4.4 ± 3.0 years. At the end of follow-up, 57 patients (72.2%) were still receiving SNM. The 5-year success rate for FI and isolated constipation was 88.2% (95% confidence interval [CI], 80.1-97.0%) and 31.2% (95% CI, 10.2-95.5%), respectively ( ＜ 0.001). In patients with FI, involuntary evacuations per week decreased ＞ 50% in 76.1% of patients (95% CI, 67.6-86.2%) after 5 years. A lead position at S3 was associated with an improved outcome ( = 0.04). Battery exchange was necessary in 23 patients (29.1%), with a median battery life of 6.2 years. Reinterventions due to complications were necessary in 24 patients (30.4%). For these patients, the 5-year success rate was 89.0% (95% CI, 75.3-100.0%) compared to 78.4% (95% CI, 67.2-91.4%) for patients without reintervention.
SNM offers an effective sustainable treatment for FI. For constipation, lasting success of SNM is limited and is thus not recommended. Reinterventions are necessary but do not impede treatment success.
背景/目的：本研究旨在评估骶神经调节（SNM）对大便失禁（FI）和/或便秘患者治疗成功的可持续性。
这是一项对2006年至2015年间接受SNM治疗FI和/或便秘患者的前瞻性数据库的回顾性分析。在长达10年的随访后评估成功率、并发症和再次干预率。
101例患者植入了测试刺激电极，其中79例（78.2%）接受了永久性刺激。平均随访时间为4.4±3.0年。随访结束时，57例患者（72.2%）仍在接受SNM治疗。FI和单纯便秘的5年成功率分别为88.2%（95%置信区间[CI]，80.1 - 97.0%）和31.2%（95%CI，10.2 - 95.5%）（P＜0.001）。在FI患者中，5年后76.1%的患者每周非自愿排便次数减少＞50%（95%CI，67.6 - 86.2%）。S3处的电极位置与改善的结果相关（P = 0.04）。23例患者（29.1%）需要更换电池，电池中位寿命为6.2年。24例患者（30.4%）因并发症需要再次干预。对于这些患者，5年成功率为89.0%（95%CI，75.3 - 100.0%），而未进行再次干预的患者为78.4%（95%CI，67.2 - 91.4%）。
SNM为FI提供了一种有效的可持续治疗方法。对于便秘，SNM的持久成功有限，因此不推荐使用。再次干预是必要的，但并不妨碍治疗成功。
