Leroi A M, Ducrotté P, Bouaniche M, Touchais J Y, Weber J, Denis P
Groupe de Recherche sur l'Appareil Digestif, Centre Hospitalier Régional, France.
Int J Colorectal Dis. 1997;12(6):335-9. doi: 10.1007/s003840050119.
The aim of this study was to assess the reliability of cortical evoked potentials after electrical stimulation of the anal canal. Cortical evoked potentials were recorded on 243 patients presenting with perineal pain (28 patients), impotence (55 patients), anal incontinence (52 patients), urinary continence (30 patients), constipation (49 patients), and on 29 neurological patients, by stimulating the external anal sphincter and penis (or clitoris). The inter- and intra-observer reproducibility was studied by coding recordings interpreted by three different observers on two separate occasions. The influence of recording characteristics and clinical data were assessed. To study operator dependence, five operators investigated the patients. Only one of them was well trained in this technique. The interpretation of the coded curves by the observers was poorly reproducible in about 15% of cases, depending on time between the two readings and the quality of recordings. The interpretation of cerebral responses after anal stimulation were observer-dependent and influenced by the knowledge of clinical data. This was also observed with cortical evoked potentials after electrical stimulation of the penis or clitoris, but to a lesser extent. The cerebral evoked potentials method was also operator-dependent, mainly after anal stimulation. When a study of cortical evoked potentials by perineal stimulation is needed in clinical practice, it seems logical to prefer cortical evoked potentials by penile or clitoral stimulation as they seem easier to obtain than those evoked by anal stimulation if the investigators are not well trained for the performance of electrophysiological studies as the former are much less operator- and observer-dependent.
本研究的目的是评估肛管电刺激后皮质诱发电位的可靠性。通过刺激肛门外括约肌和阴茎（或阴蒂），对243例患有会阴疼痛（28例）、阳痿（55例）、肛门失禁（52例）、尿失禁（30例）、便秘（49例）的患者以及29例神经系统疾病患者记录皮质诱发电位。通过对由三名不同观察者在两个不同时间点解读的记录进行编码，研究观察者间和观察者内的可重复性。评估记录特征和临床数据的影响。为研究操作者依赖性，由五名操作者对患者进行检查。其中只有一人在该技术方面训练有素。观察者对编码曲线的解读在约15%的病例中可重复性较差，这取决于两次读数之间的时间间隔和记录质量。肛门刺激后大脑反应的解读依赖于观察者，并受临床数据知识的影响。在阴茎或阴蒂电刺激后的皮质诱发电位中也观察到了这一点，但程度较轻。大脑诱发电位方法也依赖于操作者，主要是在肛门刺激之后。在临床实践中，当需要通过会阴刺激研究皮质诱发电位时，如果研究人员没有接受过良好的电生理研究操作培训，那么选择阴茎或阴蒂刺激诱发的皮质诱发电位似乎更合理，因为前者比肛门刺激诱发的皮质诱发电位更容易获得，且前者对操作者和观察者的依赖性要小得多。
