Vernava A M, Longo W E, Daniel G L
Department of Surgery, St. Louis University School of Medicine, Missouri 63110.
Dis Colon Rectum. 1993 Jan;36(1):23-7. doi: 10.1007/BF02050297.
A prospective study was undertaken to evaluate pudendal neuropathy in fecal incontinence. Fifty-two patients (38 women and 14 men) with fecal incontinence underwent manometric and electromyographic evaluation (measurement of pudendal nerve terminal motor latency [PNTML] and sphincter muscle mapping). The average age of all patients was 54 +/- 17 years. Fifty-two percent (27/52) were found to have a pudendal neuropathy (PNTML > 2.1 milliseconds). Seventeen of these 27 patients (63 percent) had a bilateral pudendal neuropathy. Patients with a pudendal neuropathy were older than those without a neuropathy (63.7 years vs. 51.9 years; P = 0.01). Women were significantly more likely than men to have a pudendal neuropathy (P = 0.03). Nine patients had an anatomic sphincter defect identified, and six of these (67 percent) had a neuropathy; 4/6 (67 percent) had a bilateral pudendal neuropathy. In the 43 patients who did not have an anatomic sphincter defect, there was no difference in resting pressure (69 mmHg vs. 60 mmHg; P = 0.4) or maximum voluntary contraction (95 mmHg vs. 86 mmHg; P = 0.5) when patients without a neuropathy were compared with those with a neuropathy. Patients with a pudendal neuropathy had a shorter sphincter length than those without a neuropathy (3.0 cm vs. 3.9 cm; P = 0.01). Bilateral pudendal neuropathy tended to occur more frequently in women (P = 0.08) and was not associated with poorer resting pressure, maximum voluntary contraction, or shorter sphincter length. We conclude that pudendal neuropathy is a common cause of fecal incontinence, particularly in older women, and frequently occurs in association with a sphincter defect. Manometric evaluation alone is not helpful in identifying the neuropathic patient. PNTMLs should be routinely measured in the evaluation of fecal incontinence.
开展了一项前瞻性研究以评估大便失禁患者的阴部神经病变情况。52例大便失禁患者（38例女性和14例男性）接受了测压和肌电图评估（测量阴部神经终末运动潜伏期[PNTML]及括约肌肌肉图谱）。所有患者的平均年龄为54±17岁。52%（27/52）的患者被发现存在阴部神经病变（PNTML>2.1毫秒）。这27例患者中有17例（63%）为双侧阴部神经病变。存在阴部神经病变的患者比无神经病变的患者年龄更大（63.7岁对51.9岁；P=0.01）。女性比男性更易发生阴部神经病变（P=0.03）。9例患者被发现存在解剖学上的括约肌缺陷，其中6例（67%）存在神经病变；4/6（67%）为双侧阴部神经病变。在43例无解剖学括约肌缺陷的患者中，无神经病变的患者与有神经病变的患者相比，静息压力（69mmHg对60mmHg；P=0.4）或最大自主收缩力（95mmHg对86mmHg；P=0.5）并无差异。存在阴部神经病变的患者其括约肌长度比无神经病变的患者短（3.0cm对3.9cm；P=0.01）。双侧阴部神经病变在女性中似乎更常见（P=0.08），且与较差的静息压力、最大自主收缩力或较短的括约肌长度无关。我们得出结论，阴部神经病变是大便失禁的常见原因，尤其是在老年女性中，且常与括约肌缺陷相关。仅靠测压评估对识别神经病变患者并无帮助。在评估大便失禁时应常规测量PNTML。
