生物反馈疗法治疗大便失禁。长期临床结果。

Biofeedback for the treatment of fecal incontinence. Long-term clinical results.

作者信息

Guillemot F, Bouche B, Gower-Rousseau C, Chartier M, Wolschies E, Lamblin M D, Harbonnier E, Cortot A

机构信息

Hôpital Claude Huriez, Lille, France.

出版信息

Dis Colon Rectum. 1995 Apr;38(4):393-7. doi: 10.1007/BF02054228.

DOI:10.1007/BF02054228

PMID:7720447

Abstract

UNLABELLED

Biofeedback therapy has been proposed as a treatment for fecal incontinence with good, short-term results.

PURPOSE

This study was designed to assess long-term clinical results of biofeedback therapy compared with medical therapy alone and to assess manometric results in patients treated with biofeedback.

METHODS

Two groups of incontinent patients were studied. Group 1 consisted of 16 patients (3 males and 13 females; mean age, 59.9 years). Etiologies treated by biofeedback included descending perineum syndrome (7), postfistula or hemorroidectomy (4), and miscellaneous (5). Group 2 consisted of eight patients (two males, six females; mean age, 62.2 years). Etiologies treated with medical treatment alone (including enema and antidiarrheal therapy) included descending perineum syndrome (3), postfistula or hemorroidectomy (2), and miscellaneous (3). The incontinence score was initially 17.81 +/- 3.27 (standard deviation) in Group 1 and 17.0 +/- 2.77 in Group 2. Resting pressure of the upper and lower anal sphincter, maximum squeezing pressure, and duration of contraction were not initially different in Groups 1 and 2 but were significantly lower than in the control group of patients without incontinence (n = 12; 8 males, 4 females; mean age, 66.4 years) (P < 0.05). Follow-up duration was 30 months, with intermediate clinical score at 6 months for Group 1.

RESULTS

After biofeedback therapy, the incontinence score at 30 months was lower in Group 1 (14.43 +/- 6.35 vs. 17.81 +/- 3.27; P < 0.035) and unchanged in Group 2 (18.0 +/- 2.72 vs. 17.0 +/- 2.77). However, in Group 1 the score at 6 months was much lower than at 30 months (6.31 +/- 7.81 vs. 14.43 +/- 6.35; P < 0.001). Only the amplitude of voluntary contraction and upper anal pressure (51.1 (range, 27-90) vs 36.7 (range, 20-80) mmHg) were significantly increased (81.5 (range, 55-120) vs. 62.1 (range, 30-90) mmHg; P < 0.05).

CONCLUSION

Biofeedback improved continence at 6 months and at 30 months. However, the score at 6 months was much better, suggesting that the initial good results may deteriorate over a long time. These data suggest that it could be useful to reinitiate biofeedback therapy in some patients.

摘要

未标注

生物反馈疗法已被提议作为一种治疗大便失禁的方法，短期效果良好。

目的

本研究旨在评估生物反馈疗法与单纯药物治疗相比的长期临床效果，并评估接受生物反馈治疗患者的测压结果。

方法

对两组大便失禁患者进行研究。第1组由16名患者组成（3名男性和13名女性；平均年龄59.9岁）。生物反馈治疗的病因包括会阴下降综合征（7例）、肛瘘或痔切除术后（4例）以及其他（5例）。第2组由8名患者组成（2名男性，6名女性；平均年龄62.2岁）。单纯药物治疗（包括灌肠和止泻治疗）的病因包括会阴下降综合征（3例）、肛瘘或痔切除术后（2例）以及其他（3例）。第1组的失禁评分为17.81±3.27（标准差），第2组为17.0±2.77。第1组和第2组的肛门上、下括约肌静息压力、最大收缩压力和收缩持续时间最初无差异，但显著低于无失禁的对照组患者（n = 12；8名男性，4名女性；平均年龄66.4岁）（P < 0.05）。随访时间为30个月，第1组在6个月时进行中期临床评分。

结果

生物反馈治疗后，第1组在30个月时的失禁评分较低（14.43±6.35 vs. 17.81±3.27；P < 0.035），第2组无变化（18.0±2.72 vs. 17.0±2.77）。然而，第1组在6个月时的评分远低于30个月时（6.31±7.81 vs. 14.43±6.35；P < 0.001）。仅自主收缩幅度和肛门上压力（51.1（范围，27 - 90）vs 36.7（范围，20 - 80）mmHg）显著增加（81.5（范围，55 - 120）vs. 62.1（范围，30 - 90）mmHg；P < 0.05）。