Bittorf Birgit, Matzel Klaus
Chirurgische Klinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
Zentralbl Chir. 2023 Jun;148(3):228-236. doi: 10.1055/a-2063-3630. Epub 2023 Jun 2.
Over the last two decades, sacral neuromodulation (SNM) has established its role in the treatment of functional pelvic organ-/pelvic floor disorders. Even though the mode of action is not fully understood, SNM has become the preferred surgical treatment of fecal incontinence.
A literature search was carried out on programming sacral neuromodulation and long-term outcomes in treating fecal incontinence and constipation.Sacral neuromodulation was found to be successful in the long term. Over the years, the spectrum of indications has expanded, and now includes patients presenting with anal sphincter lesions. The use of SNM for low anterior resection syndrome (LARS) is currently under clinical investigation. Findings of SNM for constipation are less convincing. In several randomised crossover studies, no success was demonstrated, even though it is possible that subgroups may benefit from the treatment. Currently the application cannot be recommended in general.The pulse generator programming sets the electrode configuration, amplitude, pulse frequency and pulse width. Usually pulse frequency and pulse width follow a default setting (14 Hz, 210 s), while electrode configuration and stimulation amplitude are adjusted individually to the patient need and perception of stimulation.Despite low infection rates and few electrode-/pulse generator dysfunctions, up to 65% of patients require surgical reintervention during long term follow-up - in 50% of cases because of battery depletion, which is an expected event. At least one reprogramming is necessary in about 75% of the patients during the course of the treatment, mostly because of changes in effectiveness, but rarely because of pain. Regular follow-up visits appear to be advisable.
Sacral neuromodulation can be considered to be a safe and effective long-term therapy of fecal incontinence. To optimise the therapeutic effect, a structured follow-up regime is advisable.
在过去二十年中，骶神经调节（SNM）已在功能性盆腔器官/盆底疾病的治疗中确立了其作用。尽管其作用方式尚未完全明确，但SNM已成为大便失禁的首选手术治疗方法。
对骶神经调节的程控以及治疗大便失禁和便秘的长期结果进行了文献检索。发现骶神经调节长期来看是成功的。多年来，适应证范围不断扩大，现在包括存在肛门括约肌损伤的患者。目前骶神经调节用于低位前切除综合征（LARS）正在进行临床研究。骶神经调节治疗便秘的结果不太令人信服。在几项随机交叉研究中，未显示出成功，尽管可能有亚组患者可能从该治疗中获益。目前一般不推荐应用。脉冲发生器程控设定电极配置、振幅、脉冲频率和脉冲宽度。通常脉冲频率和脉冲宽度遵循默认设置（14Hz，210秒），而电极配置和刺激振幅则根据患者需求和对刺激的感知进行个体化调整。尽管感染率低且电极/脉冲发生器功能障碍少，但在长期随访中高达65%的患者需要再次手术干预——50%的情况是由于电池耗尽，这是一个预期事件。在治疗过程中约75%的患者至少需要一次重新程控，主要是因为疗效变化，但很少是因为疼痛。定期随访似乎是可取的。
骶神经调节可被认为是一种安全有效的大便失禁长期治疗方法。为优化治疗效果，建议采用结构化的随访方案。
