Abstract

Aims. Sacral nerve stimulation is a well-known treatment for fecal incontinence (FI). Standard reprogramming restores FI for some patients, but not all. A review of the literature was carried out to study this question. Methods. A literature search was performed on Pubmed and Embase databases for all relevant articles till December 2018. Studies were included if they were crossover randomized clinical trial, evaluating the use of SNS on the patient with fecal incontinence and assessing at least one of the following end-points: the frequency of fecal incontinence episodes, Cleveland Clinic incontinence score (CCIS), Fecal Incontinence Quality of Life Scale (FIQLS) and the Wexner incontinence score. No restrictions on language or study size were made. Results. Five RCT papers were identi?ed and all of those were randomized crossover study. These included 176 patients and 104 participants. The average follow-up duration for these 5 studies was 3 months. Preliminary results suggest good outcome after permanent SNS implant. Results from the first three studies showed significantly reduced frequency of fecal incontinence episodes during the ON period. All three studies reported positive outcomes with the Cleveland Clinic incontinence score (CCIS) that were significantly improved in the ON period than the OFF period. Optimal pacemaker settings were individual, but a trend towards higher patient satisfaction and decreased incontinent episodes was evident for high-frequency stimulation (31 Hz/210 μs) in comparison with the standard setting (14 Hz/210 μs) (p < 0.05). Subsensory stimulation as low as 50% of the sensory threshold is as effective as stimulation at or above the sensory threshold. Finally, bilateral stimulation is not superior to standard unilateral stimulation in the short term. Conclusions. The review suggests that SNS for fecal incontinence has significant improvement in fecal incontinence during the ON period with higher patient satisfaction and decreased incontinent episodes under high-frequency stimulation.目的:骶神經刺激是大便失禁眾所周知的治療方法。有一些但不是全部標準流程患者治療大便失禁。以文獻系統性回顧的方式研究這個問題。方法:在Pubmed和Embase數據庫中對2018年12月之前的所有相關文章進行了文獻檢索。如果是交叉隨機對照試驗,評估骶神經刺激治療對大便失禁患者的使用並評估以下至少一個端點,包括研究:大便失禁發作頻率,克利夫蘭臨床失禁評分(CCIS)和糞便失禁生活質量量表(FIQLS)。對語言或學習規模沒有限制。結果:確定了五篇隨機對照試驗論文,均為隨機交叉研究。其中包括176名患者和104名參與者。這5項研究的平均追蹤時間為3個月。初步結果表明永久性骶神經刺激治療植入後的良好結果。前三項研究的結果顯示在開啟期間大便失禁發作的頻率顯著降低。所有三項研究都報告了克利夫蘭診所尿失禁評分(CCIS)的陽性結果,其在開啟期間顯著改善,而非關閉時期。最佳刺激器設置是獨立個體的,但與標准設置(14 Hz/210μs)相比,高頻刺激(31 Hz/210μs)的患者滿意度增加和失禁發作減少的趨勢明顯(p < 0.05)。而在低至感覺閾值的50%的亞感覺刺激與在感覺閾值或高於感覺閾值的刺激一樣有效。最後,雙側刺激在短期內不優於標準的單側刺激。結論:該綜述表明,在開啟期間,骶神經刺激治療在大便失禁方面有顯著改善,患者滿意度較高,高頻刺激下失禁發作減少。
Translated title of the contribution對於骶神經刺激治療大便失禁的五項交叉試驗的總結
Original languageEnglish
Pages (from-to)89-96
Number of pages8
Journal中華民國大腸直腸外科醫學會雜誌
Volume30
Issue number3
DOIs
Publication statusPublished - Sep 1 2019

Keywords

  • Sacral nerve stimulation
  • Fecal incontinence
  • Randomized controlled trial
  • Cleveland Clinic incontinence score
  • Fecal Incontinence Quality of Life Scale
  • 骶神經刺激
  • 大便失禁
  • 隨機對照試驗論文
  • 克利夫蘭臨床失禁評分
  • 糞便失禁生活質量量表

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