Glia A, Gylin M, Akerlund J E, Lindfors U, Lindberg G
Karolinska Institutet, Department of Surgery, Huddinge University Hospital, Sweden.
Dis Colon Rectum. 1998 Mar;41(3):359-64. doi: 10.1007/BF02237492.
This study was undertaken to assess the functional results of biofeedback training in patients with fecal incontinence in relation to clinical presentation and anorectal manometry results.
Twenty-six consecutive patients with fecal incontinence were treated with biofeedback training using anorectal manometry pressure for visual feedback. Ten patients had passive incontinence only, six patients had urge incontinence, and ten patients had combined passive and urge incontinence.
Patients with urge incontinence had a lower maximum voluntary contraction pressure (92+/-12 mmHg) and a lower maximum tolerable volume (78+/-13 ml) than patients with passive incontinence (140+/-43 mmHg and 166+/-73 ml). Twenty-two patients completed the treatment, five patients (23 percent) showed excellent improvement, nine patients (41 percent) had good results, and eight (36 percent) patients showed no improvement. At follow-up on average of 21 months after therapy, 41 percent of our patients reported continued improvement. The maximum tolerable volume was higher in those with excellent (140.4+/-6.8 ml) or good (156.3+/-6.64 ml) results of therapy than it was in those with poor results (88.5+/-2.5 ml). Greater asymmetry of the anal sphincter also correlated to poor results.
Biofeedback therapy improved continence immediately after training and at follow-up after 21 months, but the initial results were better. The urge fecal incontinence seems to be related to function of the external anal sphincter and to the maximum tolerable volume. Low maximum tolerable volume and anal sphincter asymmetry were associated with a poor outcome of therapy.
本研究旨在评估生物反馈训练对大便失禁患者的功能效果，并分析其与临床表现及肛门直肠测压结果的关系。
连续纳入26例大便失禁患者，采用基于肛门直肠测压压力的视觉反馈进行生物反馈训练。其中10例仅为被动性失禁，6例为急迫性失禁，10例为被动性与急迫性混合失禁。
急迫性失禁患者的最大自主收缩压（92±12 mmHg）和最大耐受容量（78±13 ml）低于被动性失禁患者（分别为140±43 mmHg和166±73 ml）。22例患者完成治疗，5例（23%）显示极佳改善，9例（41%）效果良好，8例（36%）无改善。治疗后平均随访21个月，41%的患者报告仍有持续改善。治疗效果极佳（140.4±6.8 ml）或良好（156.3±6.64 ml）的患者，其最大耐受容量高于效果不佳者（88.5±2.5 ml）。肛门括约肌更大的不对称性也与较差的治疗结果相关。
生物反馈疗法在训练后即刻及21个月随访时均改善了控便能力，但初始效果更佳。急迫性大便失禁似乎与肛门外括约肌功能及最大耐受容量有关。低最大耐受容量和肛门括约肌不对称与治疗效果不佳相关。
