Sphinkeeper®在大便失禁中的应用

Kearsey Cc
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引用次数: 0

摘要

简介:粪便失禁是一种可以影响多达20%的人口在他们的一生中,女性为主的条件。骶神经刺激(SNS)最近被证明对急迫性尿失禁有显著的益处,但这使得大量的被动尿失禁患者没有有效的治疗选择。SphinKeeper®(SK)允许治疗更大的内或外肛门括约肌缺陷。初步研究表明,该方法在治疗大便失禁方面有一定的疗效。方法:在St Helens和Knowsley NHS信托进行了SphinKeeper®假体的单中心回顾性观察研究,我们相信这是英国最大的SphinKeeper®系列研究之一。SphinKeeper®通过在括约肌间隙内放置自扩张假体来恢复括约肌功能。该手术包括在内外括约肌之间植入10个自我膨胀的无菌假体,从而在肛管周围形成第三个环。结果:多数患者为ASA 2级(n=10)。43%(6/14)的患者既往有结肠直肠手术- THD和粘固定术(n=3),肛肠瘘手术(n=1),直肠前切除术(n=1)和盆底修复(n=1)。6例患者行EUS检查,均发现肛门内外括约肌缺损(IAS n=1, EAS n=3, IAS和EAS n=2)。无患者持续术中并发症。2例患者因术后疼痛严重,术后48小时内再次就诊,术后镇痛出院。主观结果采用Vaizey和Wexner评分进行评估,4/14例患者有显著改善,7/14例患者部分改善,3/14例患者无改善。讨论:我们的研究评估了2017年5月至2020年8月期间接受SphinKeeper®手术的14例患者的短期结果。参与我们研究的患者之前曾通过各种方法(内科和外科)治疗过大便失禁,并患有不同类型的FI(被动式、急迫性、混合性、相关性尿失禁)。Vaizey和Wexner评分降低(分别为p=0.00377和p=0.00334 (Wilcoxon检验))表明,11例患者的失禁有临床意义的改善,这是有希望的。我们有理由认为Sphinkeeper™是一种安全、微创的手术干预手段,可以在一定程度上改善大便失禁患者的病情。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Use of Sphinkeeper® In Faecal Incontinence
Introduction: Faecal Incontinence is a condition that can affect up to 20% of population during their lifetime with female predominance. Sacral Nerve Stimulation (SNS) has been recently shown to have significant benefits in mainly urge incontinence but this has left a large group of patients with passive incontinence without effective management options. The SphinKeeper® (SK) allows treatment of more sizeable defects in the internal or external anal sphincter. Preliminary series have shown some benefit of the procedure in treatment of faecal incontinence. Methods: A single-centre retrospective observational study of SphinKeeper® prostheses was conducted at St Helens and Knowsley NHS trust and we believe this to be one of the largest series of SphinKeeper® in the UK. SphinKeeper® restores sphincter function by using placement of self-expanding prostheses into the inter-sphincteric space. The operation involves implantation of 10 self-expanding sterile prostheses between the internal and the external sphincter, thus creating a third ring around the circumference of the anal canal. Results: Most patients were ASA 2 (n=10). 43% (6/14) patients had previous colorectal surgery – THD and mucopexy (n=3), anorectal fistula surgery (n=1), anterior resection of rectum (n=1) and pelvic floor repair (n=1). EUS was carried out in 6 patients and in all 6 cases identified internal or external anal sphincter defect (IAS n=1, EAS n=3, IAS and EAS n=2). No patient sustained intraoperative complications. 2 patients reattended within 48 hours post op due to severe post-operative pain and were discharged with analgesia. Subjective results were evaluated using Vaizey and Wexner scores and showed significant improvement 4/14 patients, partial improvement in 7/14 patients and no improvement in 3/14 patients. Discussion: Our study evaluated the short-term outcomes of the procedure in 14 patients who had SphinKeeper® surgery between May 2017 and August 2020. Patients who took part in our study had previous treatment for faecal incontinence by a variety of methods (both medical and surgical) and suffered from different types of FI (passive, urge, mixed, associated urinary incontinence). It was promising to see there was a clinically significant improvement in continence indicated by a decrease in Vaizey and Wexner scores (p=0.00377 and p=0.00334 respectively (Wilcoxon test)) with 11 patients improving in scores. It is reasonable to consider Sphinkeeper™ as a safe and minimally invasive surgical intervention to achieve some degree of positive improvement for patients suffering from faecal incontinence.
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