Sangwan Y P, Coller J A, Barrett R C, Roberts P L, Murray J J, Schoetz D J
Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts 01805, USA.
Dis Colon Rectum. 1995 Oct;38(10):1021-5. doi: 10.1007/BF02133972.
Biofeedback therapy may improve fecal control in up to 50 percent to 92 percent of patients with fecal incontinence. Identification of favorable manometric parameters before biofeedback therapy may help in selection of patients suitable for such therapy.
Twenty-eight patients with fecal incontinence (idiopathic, 11; iatrogenic trauma, 8; obstetric trauma, 9) who underwent biofeedback therapy were studied to determine whether manometric parameters could predict the result of therapy. Biofeedback was given using a computer software program designed to strengthen the external anal sphincter with auditory and visual feedback.
Thirteen patients (46.4 percent) achieved excellent results; eight patients (28.6 percent) had good results, but seven patients (24.5 percent) failed to improve after biofeedback therapy. Resting or squeeze anal canal pressure, pressure volume, sphincter length, sphincter fatigue rate, and cross-sectional asymmetry of the entire sphincter before biofeedback failed to reveal any statistically significant differences between responders and nonresponders. However, the cross-sectional asymmetry of the high-pressure zone within the sphincter at rest was greater in nonresponders than in responders (not improved, 25.8 percent; good result, 20.2 percent; excellent result, 15.4 percent; P < 0.07). This difference was even greater on squeeze (not improved, 21 percent; good result, 17.6 percent; excellent result, 13.2 percent; P < 0.04). The number of biofeedback sessions, response on bearing down, and quality of rectoanal excitatory reflex were not reliable indicators of outcome. No statistical difference was found in mean resting and squeeze pressures after biofeedback between responders and non-responders.
Except for increased cross-sectional asymmetry in the high-pressure zone, which may be a forerunner of adverse outcome, manometric parameters before biofeedback do not predict response to biofeedback therapy. Improvement in continence may be independent of resting and squeeze pressures achieved after biofeedback therapy.
生物反馈疗法可使高达50%至92%的大便失禁患者改善大便控制能力。在生物反馈疗法前确定有利的测压参数可能有助于选择适合该疗法的患者。
对28例接受生物反馈疗法的大便失禁患者（特发性11例、医源性创伤8例、产科创伤9例）进行研究，以确定测压参数是否能预测治疗结果。使用设计用于通过听觉和视觉反馈增强肛门外括约肌的计算机软件程序进行生物反馈。
13例患者（46.4%）取得了极佳效果；8例患者（28.6%）效果良好，但7例患者（24.5%）在生物反馈疗法后未得到改善。生物反馈前的静息或收缩肛管压力、压力容积、括约肌长度、括约肌疲劳率以及整个括约肌的横截面不对称性，在反应者和无反应者之间未显示出任何统计学上的显著差异。然而，静息时括约肌内高压区的横截面不对称性在无反应者中比反应者更大（未改善者为25.8%；效果良好者为20.2%；效果极佳者为15.4%；P<0.07）。收缩时这种差异更大（未改善者为21%；效果良好者为17.6%；效果极佳者为13.2%；P<0.04）。生物反馈治疗的次数、用力排便时的反应以及直肠肛门兴奋性反射的质量并非疗效的可靠指标。反应者和无反应者在生物反馈后的平均静息和收缩压力方面未发现统计学差异。
除了高压区横截面不对称性增加（这可能是不良结果的先兆）外，生物反馈前的测压参数无法预测对生物反馈疗法的反应。大便失禁的改善可能与生物反馈疗法后达到的静息和收缩压力无关。
