Pla-Martí Vicente, Martín-Arévalo Jose, Martí-Fernández Rosa, Moro-Valdezate David, García-Botello Stephanie, Espí-Macías Alejandro, Mínguez-Pérez Miguel, Ruiz-Carmona Maria Dolores, Roig-Vila Jose Vicente
Department of Surgery, University of Valencia, Valencia, Spain.
Colorectal Unit, Department of General and Digestive Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Ann Coloproctol. 2022 Feb 28;38(1):13-19. doi: 10.3393/ac.2020.09.16. Epub 2020 Sep 18.
Evaluate the long-term evolution of continence and patient's quality of life after surgical treatment for obstetric fecal incontinence.
A prospective longitudinal study was conducted including consecutive patients who underwent sphincteroplasty for severe obstetric fecal incontinence. The first phase analyzed changes in continence and impact on quality of life. The second phase studied the long-term evolution reevaluating the same group of patients six years later. Degree of fecal incontinence was calculated using the Cleveland Clinic Score. Quality of life assessment was carried out with the Fecal Incontinence Quality of Life Scale.
35 patients with median age of 55 (range, 28-73) completed the study. Phase One Results: After a postoperative follow-up of 30 months (4-132), Cleveland Clinic Score had improved significantly from a preoperative of 15.7 ± 3.1 to 6.1 ± 5 (p <0.001). Phase Two Results: median follow-up in phase two was 110 months (76- 204). The Cleveland Clinic Score lowered to 8.4 ± 4.9 (p = 0.04). There were no significant differences between phases one and two in terms of quality of life: lifestyle (3.47 ± 0.75 vs. 3.16 ± 1.04), coping/behavior (3.13 ± 0.83 vs 2.80 ± 1.09), depression/self-perception (3.65 ± 0.80 vs 3.32 ± 0.98) and embarrassment (3.32 ± 0.9 vs 3.12 ± 1).
Sphincteroplasty offers good short-medium term outcomes in continence and quality of life for obstetric fecal incontinence treatment. Functional clinical results deteriorate over time but did not impact on patients' quality of life.
评估产科粪便失禁手术治疗后控便能力的长期演变及患者的生活质量。
进行了一项前瞻性纵向研究，纳入了因严重产科粪便失禁接受括约肌成形术的连续患者。第一阶段分析控便能力的变化及其对生活质量的影响。第二阶段对同一组患者在六年后进行重新评估，研究其长期演变情况。使用克利夫兰诊所评分计算粪便失禁程度。采用粪便失禁生活质量量表进行生活质量评估。
35例患者完成了研究，中位年龄为55岁（范围28 - 73岁）。第一阶段结果：术后随访30个月（4 - 132个月），克利夫兰诊所评分从术前平均15.7±3.1显著改善至6.1±5（p<0.001）。第二阶段结果：第二阶段的中位随访时间为110个月（76 - 204个月）。克利夫兰诊所评分降至8.4±4.9（p = 0.04）。在生活质量方面，第一阶段和第二阶段之间无显著差异：生活方式（3.47±0.75对3.16±1.04）、应对/行为（3.13±0.83对2.80±1.09）、抑郁/自我认知（3.65±0.80对3.32±0.98）和尴尬程度（3.32±0.9对3.12±1）。
括约肌成形术在产科粪便失禁治疗的控便能力和生活质量方面提供了良好的中短期效果。随着时间推移，功能临床结果会恶化，但对患者生活质量没有影响。
