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比较骶神经刺激治疗便秘和粪便失禁的长期疗效,重点关注取出率、额外就诊次数和患者满意度。

Comparison of long-term outcome of sacral nerve stimulation for constipation and faecal incontinence with focus on explantation rate, additional visits, and patient satisfaction.

机构信息

Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark.

Hidaka Coloproctology Clinic, Kurume, Japan.

出版信息

Tech Coloproctol. 2020 Nov;24(11):1189-1195. doi: 10.1007/s10151-020-02328-0. Epub 2020 Aug 27.

Abstract

BACKGROUND

The aim of the present study was to compare sacral nerve stimulation (SNS) for constipation (SNS-C) with SNS for idiopathic faecal incontinence (SNS-IFI) regarding explantation rate, additional visits, and improvement of patient satisfaction 5 years after implantation.

METHODS

From our prospective database (launched in 2009), we extracted all SNS-C patients 5 years post-implantation, and the SNS-IFI patients implanted just before and just after each SNS-C patient. We retrospectively evaluated the explantation rate, number of additional visits, and patient satisfaction using a visual analogue scale (VAS). We hypothesized that compared with those in the SNS-IFI group: (1) the explantation rate would be higher in SNS-C patients, (2) the number of additional visits would be higher in SNS-C patients, and (3) in patients with an active implant at 5 years, the improvement in VAS would be the same.

RESULTS

We included 40 SNS-C patients and 80 SNS-IFI patients. In the SNS-C group 7/40 (17.5%), patients were explanted, compared to 10/80 (12.5%) patients in the SNS-IFI group (p = 0.56). The mean number of additional visits in the SNS-C group was 3.5 (95% CI 2.8-4.1)) and 3.0 (95% CI 2.6-3.6)) in the SNS-IFI group (p = 0.38). Additional visits due to loss of efficacy were significantly higher in the SNS-C patients (p = 0.03). The reduction in VAS score (delta VAS) at 5 years was 37.1 (95% CI 20.9-53.3) in the SNS-C group, and 46.0 (95% CI 37.9-54.0) in the SNS-IFI group (p = 0.27).

CONCLUSIONS

No significant difference was found regarding explantation rate, number of additional visits, or improvement of VAS at 5 years after SNS implantation between SNS-C patients and SNS-IFI patients.

摘要

背景

本研究旨在比较骶神经刺激(SNS)治疗便秘(SNS-C)与 SNS 治疗特发性粪便失禁(SNS-IFI)的 5 年后的再次手术率、额外就诊次数以及患者满意度。

方法

我们从我们的前瞻性数据库(2009 年启动)中提取了所有植入后 5 年的 SNS-C 患者,以及在每个 SNS-C 患者之前和之后植入的 SNS-IFI 患者。我们使用视觉模拟量表(VAS)回顾性评估了再次手术率、额外就诊次数和患者满意度。我们假设与 SNS-IFI 组相比:(1)SNS-C 患者的再次手术率更高;(2)SNS-C 患者的额外就诊次数更多;(3)在 5 年内有活动植入物的患者,VAS 的改善程度相同。

结果

我们纳入了 40 名 SNS-C 患者和 80 名 SNS-IFI 患者。在 SNS-C 组中,有 7/40(17.5%)名患者进行了再次手术,而在 SNS-IFI 组中,有 10/80(12.5%)名患者进行了再次手术(p=0.56)。SNS-C 组的平均额外就诊次数为 3.5(95%CI 2.8-4.1)次,SNS-IFI 组为 3.0(95%CI 2.6-3.6)次(p=0.38)。SNS-C 组因疗效丧失而导致的额外就诊次数明显更高(p=0.03)。SNS-C 组 5 年后 VAS 评分(delta VAS)下降 37.1(95%CI 20.9-53.3),SNS-IFI 组下降 46.0(95%CI 37.9-54.0)(p=0.27)。

结论

在 SNS 植入后 5 年,SNS-C 患者与 SNS-IFI 患者在再次手术率、额外就诊次数或 VAS 改善方面无显著差异。

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