经皮胫神经刺激治疗大便失禁的长期疗效和部分缓解者的新方法,Techniques in Coloproctology

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经皮胫神经刺激治疗大便失禁的长期疗效和部分缓解者的新方法
Techniques in Coloproctology ( IF 2.7 ) Pub Date : 2022-10-12 , DOI: 10.1007/s10151-022-02711-z
M Bosch-Ramírez ₁ , L Sánchez-Guillén ₁ , M J Alcaide-Quirós ₁ , M M Aguilar-Martínez ₁ , M Bellón-López ₁ , A López Delgado ₁ , F López-Rodríguez-Arias ₁ , A Muñoz-Duyos ₂ , X Barber-Valles _{1,

3,

4} , A Arroyo ₁

Affiliation

背景

本研究的目的是评估经皮胫神经刺激（PTNS）对保守治疗难治性大便失禁（FI）患者的长期疗效。次要目标是确定缓解的预测因素并验证部分缓解者的新治疗途径。

方法

2010 年 1 月至 2017 年 6 月期间，在一所大学医院的排便障碍专科病房对保守治疗难治的 18 岁以上排便障碍患者进行了一项前瞻性介入研究。30 分钟的 PTNS 课程分三个阶段（每周、每两周和每月）进行，长达一年，并在 3、6、12 和 36 个月时进行临床重新评估。

当治疗前 Wexner 评分下降 > 50% 时，患者被归类为最佳反应者；当下降 25-50% 时，部分有反应；如果下降 < 25%，则响应者不足。只有最佳反应者和部分反应者才能进入连续阶段。

结果

2010 年至 2017 年间，招募了 139 名患者（110 名女性，中位年龄 63 岁[范围 22-82 岁]）。第一阶段结束后，4 名患者为最佳反应者，93 名患者为部分反应者，36 名患者为不足反应者。6 个月和 12 个月时，分别有 66 名和 89 名患者达到最佳反应，治疗结束时最佳反应率为 64%。总共93.3%的最初部分缓解的患者最终成为最佳缓解者。此外，在36个月时，71.9%的患者在没有补充治疗的情况下仍然是最佳反应者，尽管他们的生活质量没有显着改善。基线 Wexner 评分 ≤ 10 和症状持续时间 < 1 年被确定为 PTNS 阳性反应的预测因素。

结论

按照该方案接受 PTNS 1 年的患者具有最佳的长期反应。对部分缓解的患者进行长达 1 年的 PTNS 治疗，可以防止大部分患者需要更具侵入性的治疗，并让最佳缓解的患者保持长期节制。

"点击查看英文标题和摘要"

Long-term efficacy of percutaneous tibial nerve stimulation for faecal incontinence and a new approach for partial responders

Background

The aim of the present study was to evaluate the long-term efficacy of percutaneous tibial nerve stimulation (PTNS) for patients with faecal incontinence (FI) refractory to conservative treatment. Secondary aims were to identify predictors of response and validate new treatment pathways for partial responders.

Methods

A prospective, interventional study was carried out in a specialist defecatory disorder unit from a university hospital between January 2010 and June 2017 on patients > 18 years old with FI refractory to conservative treatment. Thirty-minute PTNS sessions were performed in three phases (weekly, biweekly and monthly) up to a year, with clinical reassessment at 3, 6, 12 and 36 months.

Patients were classified as optimal responders when their pretreatment Wexner score decreased > 50%; partial responders when it decreased 25–50%; and insufficient responders if it decreased < 25%. Only optimal and partial responders progressed into successive phases.

Results

Between 2010 and 2017, 139 patients (110 women, median age 63 years [range 22–82 years]) were recruited. After the first phase, 4 patients were optimal responders, 93 were partial responders and 36 were insufficient responders. At 6 and 12 months, 66 and 89 patients respectively were optimal responders, with an optimal response rate of 64% at the end of treatment. A total of 93.3% patients with a partial response initially finally became optimal responders. Furthermore, at 36 months, 71.9% of patients were still optimal responders without supplementary treatment, although their quality of life did not improve significantly. Baseline Wexner scores ≤ 10 and symptom duration < 1 year were identified as predictive factors for positive responses to PTNS.

Conclusions

Patients undergoing PTNS for 1 year following this protocol had optimal long-term responses. PTNS sessions for up to 1 year in patients who were partial responders prevents a high percentage of them from needing more invasive treatments, and maintains long-term continence in patients who were optimal responders.

更新日期：2022-10-13

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