INTRODUCTION Although the combination of transcutaneous sacral nerve stimulation (tSNS) and pelvic floor exercises (PFEs) has shown significant effectiveness in treating fecal incontinence (FI) after surgery for congenital anorectal malformation (CARM), not all patients achieve satisfactory continence. Therefore, identifying which individuals will benefit from this method is crucial. METHODS A prospective cohort study enrolled 92 children with FI. All patients underwent tSNS with PFE treatment, and an improved outcome was defined as a Wexner score ≤4. A predictive model to identify the effects of tSNS with PFEs in FI was developed based on the analysis of magnetic resonance imaging and high-resolution anorectal manometry with area under the receiver-operating characteristic curve to evaluate the predictive value of external anal sphincter (EAS) thickness index and anal squeezing pressure (ASP). RESULTS tSNS with PFEs improved outcomes in 72 patients and led to poor outcomes in 20 (4 had their rectums deviate from the puborectalis muscle center or puborectal muscle ruptures while 16 lacked EAS with a lower ASP). The areas under the receiver-operating characteristic curve for EAS thickness index and ASP in predicting the effects of tSNS with PFEs were 0.915 (95% confidence interval 0.846-0.983, P = 0.000) and 0.886 (95% confidence interval 0.819-0.952, P = 0.000), respectively. By applying cutoff values of 0.076 for EAS thickness index and 21.95 mm Hg for ASP, tSNS with PFEs was found to be ineffective. DISCUSSION tSNS with PFEs is effective for most patients with FI after CARM surgery, except when the rectum deviates from the puborectal muscle center, puborectal muscle rupture occurs, or EAS is absent with a low ASP.

中文翻译：

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一种预测模型，用于识别经皮骶神经刺激与盆底运动对肛门直肠畸形手术后大便失禁的影响。

引言 虽然经皮骶神经刺激 (tSNS) 和盆底运动 (PFE) 相结合在治疗先天性肛门直肠畸形 (CARM) 术后大便失禁 (FI) 方面显示出显着的疗效，但并非所有患者都能达到满意的失禁效果。因此，确定哪些人将从这种方法中受益至关重要。方法 一项前瞻性队列研究纳入了 92 名 FI 儿童。所有患者均接受 tSNS 联合 PFE 治疗，改善的结果定义为 Wexner 评分≤4。基于磁共振成像和高分辨率肛门直肠测压法以及接受者操作特征曲线下面积的分析，开发了一种识别 tSNS 与 PFE 在 FI 中的影响的预测模型，以评估肛门外括约肌 (EAS) 的预测价值厚度指数和肛门挤压压力（ASP）。结果 tSNS 联合 PFE 改善了 72 名患者的预后，但导致 20 名患者的预后较差（4 名患者的直肠偏离耻骨直肠肌中心或耻骨直肠肌破裂，而 16 名患者缺乏 EAS，ASP 较低）。EAS 厚度指数和 ASP 预测 tSNS 与 PFE 效果的受试者工作特征曲线下面积分别为 0.915（95% 置信区间 0.846-0.983，P = 0.000）和 0.886（95% 置信区间 0.819-0.952，P） = 0.000），分别。通过应用 EAS 厚度指数的截止值 0.076 和 ASP 的截止值 21.95 mm Hg，发现具有 PFE 的 tSNS 无效。讨论 tSNS 结合 PFE 对 CARM 手术后大多数 FI 患者有效，除非直肠偏离耻骨直肠肌肉中心、发生耻骨直肠肌肉破裂或 EAS 缺失且 ASP 较低。