Baeten C G, Geerdes B P, Adang E M, Heineman E, Konsten J, Engel G L, Kester A D, Spaans F, Soeters P B
Department of General Surgery, Maastricht University Hospital, Maastricht, The Netherlands.
N Engl J Med. 1995 Jun 15;332(24):1600-5. doi: 10.1056/NEJM199506153322403.
In patients with intractable fecal incontinence, conventional treatment is not always successful. Dynamic graciloplasty (transposition of the gracilis muscle to the anus with the implantation of stimulating electrodes) was developed to provide such patients with functional neosphincters. We evaluated the clinical results of this new surgical approach and the effects on quality of life.
We treated 52 patients with dynamic graciloplasty. The clinical results of treatment were evaluated in an interview, by anal manometry, and by enema testing. The degree of continence was scored. To assess quality of life, four questionnaires were administered (parts 1 and 2 of the Nottingham Health Profile, the State-Trait Anxiety Inventory, and the Self-rating Depression scale).
Among the 52 patients, 38 (73 percent) were continent after a median follow-up of 2.1 years. At 52 weeks the patients' condition had improved with respect to the median frequency of defecation (from five to two times per 24 hours, P < 0.001), the median time defecation could be postponed (from 9 seconds to 19 minutes, P = 0.012), and the median time an enema could be retained (from 0 to 180 seconds, P = 0.005). Patients in whom the technique was successful became less anxious than those in whom it failed (P = 0.002) and improved with regard to effectiveness in their occupations, ability to perform tasks around the home, personal relationships, sexual function, and social life (P = 0.01). They also became less isolated socially (P = 0.05).
Dynamic graciloplasty is a safe and reliable technique in patients with severe incontinence and may result in a better quality of life.
在顽固性大便失禁患者中,传统治疗并非总能成功。动态股薄肌成形术(将股薄肌移位至肛门并植入刺激电极)旨在为这类患者提供功能性新括约肌。我们评估了这种新手术方法的临床结果及其对生活质量的影响。
我们对52例患者实施了动态股薄肌成形术。通过访谈、肛门测压和灌肠试验评估治疗的临床结果。对控便程度进行评分。为评估生活质量,发放了四份问卷(诺丁汉健康量表第1和第2部分、状态-特质焦虑量表以及自评抑郁量表)。
在52例患者中,中位随访2.1年后,38例(73%)实现了控便。在52周时,患者的排便情况有改善,排便中位频率(从每24小时5次降至2次,P<0.001)、排便可推迟的中位时间(从9秒增至19分钟,P=0.012)以及灌肠可保留的中位时间(从0秒增至180秒,P=0.005)均有所变化。手术成功的患者比失败的患者焦虑程度减轻(P=0.002),在工作效率、在家中执行任务的能力、人际关系、性功能和社交生活方面有所改善(P=0.01)。他们在社交上也不再那么孤立(P=0.05)。
动态股薄肌成形术对于重度失禁患者是一种安全可靠的技术,可能会带来更好的生活质量。