Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Surgery, Division of Pediatric Surgery, Indianapolis, IN, USA; The Indiana University School of Medicine, Indianapolis, IN, USA.
J Pediatr Surg. 2023 Aug;58(8):1594-1599. doi: 10.1016/j.jpedsurg.2023.04.007. Epub 2023 Apr 20.
The goal of this study was to evaluate outcomes in patients treated with sacral nerve stimulation (SNS) for medically refractory fecal incontinence or severe constipation.
We performed a retrospective cohort study of all patients treated with SNS after failed medical management at a single center between 9/1/2015 and 6/30/2022. Demographic and clinical data was extracted from the electronic medical record. Rates of involuntary bowel movements were evaluated using a bowel severity score questionnaire and compared pre- and post-SNS using McNemar and McNemar-Bowker tests.
70 patients underwent SNS placement. The median age was 12.8 years (IQR 8.6-16.0) and 61.4% were male. The most common diagnosis was idiopathic constipation (67.1%), followed by anorectal malformation (15.7%), and others. 43 patients had severity scores recorded both pre- and at least 90 days post-SNS insertion. The rates of daytime and nighttime involuntary bowel movements were significantly different pre-compared to post-SNS placement (p = 0.038 and p = 0.049, respectively). The rate of daytime and nighttime fecal continence increased from 44% to 58.1% and 53.5%-83.7%, respectively. The rate of at least weekly daytime and nighttime fecal incontinence decreased from 48.8% to 18.7% and 34.9%-7.0%, respectively. Minor pain/neurological symptoms occurred in 40% of patients, while 5.7% developed a wound infection. Further surgery for the SNS was required in 40% of patients.
SNS placement can be an effective treatment for medically refractory fecal incontinence. Minor complications and the need for further procedures are common, while more serious complications like wound infections are rare.
Retrospective Cohort Study.
Level 3.
本研究的目的是评估在单一中心接受骶神经刺激（SNS）治疗的患者的治疗结果，这些患者在接受药物治疗失败后出现难治性粪便失禁或严重便秘。
我们对 2015 年 9 月 1 日至 2022 年 6 月 30 日期间在单一中心接受 SNS 治疗的所有患者进行了回顾性队列研究。从电子病历中提取人口统计学和临床数据。使用粪便严重程度评分问卷评估非自愿性排便频率，并使用 McNemar 和 McNemar-Bowker 检验比较 SNS 治疗前后的结果。
70 例患者接受了 SNS 植入术。中位年龄为 12.8 岁（IQR 8.6-16.0），61.4%为男性。最常见的诊断是特发性便秘（67.1%），其次是肛门直肠畸形（15.7%）和其他疾病。43 例患者在 SNS 植入前后均记录了严重程度评分。与 SNS 植入前相比，白天和夜间非自愿性排便的发生率差异有统计学意义（p=0.038 和 p=0.049）。白天和夜间粪便失禁的发生率分别从 44%增加到 58.1%和从 53.5%增加到 83.7%。每周至少一次白天和夜间粪便失禁的发生率从 48.8%降至 18.7%和从 34.9%降至 7.0%。40%的患者出现轻微疼痛/神经症状，5.7%的患者发生伤口感染。40%的患者需要进一步手术治疗 SNS。
SNS 植入术对药物难治性粪便失禁是一种有效的治疗方法。轻微并发症和需要进一步手术的情况很常见，而严重并发症如伤口感染则很少见。
回顾性队列研究。
3 级。
