切换至 "中华医学电子期刊资源库"

中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (07) : 696 -700. doi: 10.3877/cma.j.issn.1674-0785.2022.07.018

综述

大便失禁治疗技术的研究进展
肖国中1, 林宏城2,()   
  1. 1. 510655 广东广州,中山大学附属第六医院中西医结合肛肠外科;510655 广东广州,广东省结直肠盆底疾病研究重点实验室
  • 收稿日期:2022-03-08 出版日期:2022-07-15
  • 通信作者: 林宏城
  • 基金资助:
    国家自然科学基金面上项目(82174369,81973847); 广东省自然科学基金面上项目(2020A1515011254); 国家临床重点专科

Advances in therapeutic techniques for fecal incontinence

Guozhong Xiao1, Hongcheng Lin2,()   

  1. 1. Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
    2. Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
  • Received:2022-03-08 Published:2022-07-15
  • Corresponding author: Hongcheng Lin
引用本文:

肖国中, 林宏城. 大便失禁治疗技术的研究进展[J]. 中华临床医师杂志(电子版), 2022, 16(07): 696-700.

Guozhong Xiao, Hongcheng Lin. Advances in therapeutic techniques for fecal incontinence[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(07): 696-700.

目的

大便失禁是结直肠肛门疾病中的常见病和难治病,通常会给患者生活质量造成严重影响。目前针对大便失禁的治疗选择众多但尚缺乏统一规范,大便失禁的治疗一般先从非手术治疗开始,包括一般治疗、药物治疗、生物反馈治疗以及针灸治疗。当非手术治疗无效时选择手术治疗,常见的手术治疗包括:括约肌修补术、股薄肌转移成形术、人工括约肌植入术、磁性肛门括约肌、生物材料注射、骶神经调节术、肛门干细胞疗法及结肠造口。本文就大便失禁的治疗技术做阐述,有助于肛肠科医生深入了解大便失禁的治疗并适当选择不同治疗技术在临床工作中开展。

Fecal incontinence (FI) is a common and difficult-to-treat disease in colorectal and anal diseases, and it usually has a serious impact on the quality of life of patients. At present, there are many treatment options for FI, but there is still no unified standard. The treatment of FI generally starts with non-surgical treatment, including general treatment, drug treatment, biofeedback treatment, and acupuncture treatment. Surgical treatment is chosen when non-surgical treatment fails. Surgical treatments include sphincter repair, graciloplasty, artificial sphincter implantation, magnetic anal sphincter, biomaterial injection, sacral nerve modulation, anus stem cell therapy, and colostomy. This article elaborates on the therapeutic techniques for FI, hoping to help anorectal surgeons have a deep understanding of the treatment of FI and select appropriate therapeutic techniques in the clinical work.

1
Bharucha AE, Wald A, Enck P, et al. Functional anorectal disorders [J]. Gastroenterology, 2006, 130(5): 1510-1518.
2
Paquette IM, et al. The American society of colon and rectal surgeons' clinical practice guideline for the treatment of fecal incontinence [J]. Dis Colon Rectum, 2015, 58(7): 623-636.
Paquette IM, Varma MG, Kaiser AM, et al. The American society of colon and rectal surgeons' clinical practice guideline for the treatment of fecal incontinence [J]. Dis Colon Rectum, 2015, 58(7): 623-636.
3
Bharucha AE, Zinsmeister AR, Locke GR, et al. Symptoms and quality of life in community women with fecal incontinence [J]. Clin Gastroenterol Hepatol, 2006, 4(8): 1004-1009.
4
Saldana Ruiz N, Kaiser AM. Fecal incontinence - challenges and solutions [J]. World J Gastroenterol, 2017, 23(1): 11-24.
5
Rao SS, American College of Gastroenterology Practice Parameters Committee. Diagnosis and management of fecal incontinence [J]. American College of Gastroenterology Practice Parameters Committee. Am J Gastroenterol, 2004, 99(8): 1585-1604.
6
Ng KS, Sivakumaran Y, Nassar N, et al. Fecal incontinence: community prevalence and associated factors--a systematic review [J]. Dis Colon Rectum, 2015, 58(12): 1194-1209.
7
Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in US adults: epidemiology and risk factors [J]. Gastroenterology, 2009, 137(2): 512-517, 517.e1-2.
8
Ditah I, Devaki P, Luma HN, et al. Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005-2010 [J]. Clin Gastroenterol Hepatol, 2014, 12(4): 636-43.e1-2.
9
Rao SS, Welcher K, Zimmerman B, et al. Is coffee a colonic stimulant? [J]. Eur J Gastroenterol Hepatol, 1998, 10(2): 113-118.
10
Wald A, Back C, Bayless TM. Effect of caffeine on the human small intestine [J]. Gastroenterology. 1976, 71(5): 738-742.
11
Rao SS, Sadeghi P, Beaty J, et al. Ambulatory 24-h colonic manometry in healthy humans [J]. Am J Physiol Gastrointest Liver Physiol, 2001, 280(4): G629-G639.
12
孙桂东, 邵万金. 成人大便失禁的诊断和治疗 [J]. 临床外科杂志, 2018, 26(4): 313-316.
13
Sun WM, Read NW, Verlinden M. Effects of loperamide oxide on gastrointestinal transit time and anorectal function in patients with chronic diarrhoea and faecal incontinence [J]. Scand J Gastroenterol. 1997, 32(1): 34-38.
14
Read M, Read NW, Barber DC, et al. Effects of loperamide on anal sphincter function in patients complaining of chronic diarrhea with fecal incontinence and urgency [J]. Dig Dis Sci, 1982, 27(9): 807-814.
15
ACOG Practice Bulletin No. 210: fecal incontinence [J]. Obstet Gynecol, 2019, 133(4): e260-e273.
16
刘妮妮, 沈梅红, 丁曙晴. 深刺八髎穴为主治疗糖尿病性大便失禁1例 [J]. 针灸临床杂志, 2012, 28(3): 42-43.
17
任盈盈, 张相安. 生物反馈法联合中药口服治疗功能性大便失禁虚证型24例 [J]. 中医研究, 2017, 30(12): 26-28.
18
贺冠军. 补肾祛湿化浊法治疗中风二便失禁36例 [J]. 现代中医药, 2007(4): 31.
19
吴燕燕, 李保朝. 补中升提法临床运用举隅 [J]. 陕西中医函授, 1995(5): 7-8.
20
秦杨鹏. 针刺结合中药外敷治疗中风后大便失禁32例 [J]. 中国针灸, 2021, 41(1): 80.
21
徐志红, 中药敷脐治疗老年人大便失禁临床观察与护理 [J]. 内蒙古中医药, 2015, 34(9): 55-56.
22
Ko CY, Tong J, Lehman RE, et al. Biofeedback is effective therapy for fecal incontinence and constipation [J]. Arch Surg, 1997, 132(8): 829-33; discussion 833-834.
23
Norton C, Chelvanayagam S, Wilson-Barnett J, et al. Randomized controlled trial of biofeedback for fecal incontinence [J]. Gastroenterology, 2003, 125(5): 1320-1329.
24
Öztürk Ö, Özin Y, Bacaksız F, et al. The efficacy of biofeedback treatment in patients with fecal incontinence [J]. Turk J Gastroenterol, 2021, 32(7): 567-574.
25
周芳玲. 针刺联合生物反馈治疗功能性大便失禁的临床疗效及分析 [M]. 2020, 南京中医药大学.
26
王晓锋, 田雪峰, 李华山. 针灸治疗排粪失禁规律分析及研究质量评价 [J]. 中华中医药杂志, 2019, 34(8): 3714-3717.
27
董青军, 梁宏涛, 王琛, 等. 电针足三里及八髎穴治疗复杂性肛瘘术后大便失禁的临床观察 [J]. 上海中医药杂志, 2018, 52(10): 67-69.
28
陈波翰, 唐成林, 田丰玮. 八髎穴烧山火手法治疗肛门失禁研究进展 [J]. 实用中医药杂志, 2020, 36(10): 1361-1363.
29
Takahashi T. Mechanism of acupuncture on neuromodulation in the gut--a review [J]. Neuromodulation, 2011, 14(1): 8-12; discussion 12.
30
Sipaviciute A, Aukstikalnis T, Samalavicius NE, Dulskas A. The role of traditional acupuncture in patients with fecal incontinence-mini-review [J]. Int J Environ Res Public Health, 2021, 18(4): 2112.
31
Wexner SD, Bleier J. Current surgical strategies to treat fecal incontinence [J]. Expert Rev Gastroenterol Hepatol, 2015, 9(12): 1577-1589.
32
Johnson E, Carlsen E, Steen TB, et al. Short- and long-term results of secondary anterior sphincteroplasty in 33 patients with obstetric injury [J]. Acta Obstet Gynecol Scand, 2010, 89(11): 1466-1472.
33
Zutshi M, Tracey TH, Bast J, et al. Ten-year outcome after anal sphincter repair for fecal incontinence [J]. Dis Colon Rectum, 2009, 52(6): 1089-1094.
34
Lehto K, Hyöty M, Collin P, et al. Seven-year follow-up after anterior sphincter reconstruction for faecal incontinence [J]. Int J Colorectal Dis, 2013, 28(5): 653-658.
35
El-Gazzaz G, Zutshi M, Hannaway C, et al. Overlapping sphincter repair: does age matter? [J]. Dis Colon Rectum, 2012, 55(3): 256-261.
36
Rotholtz NA, Wexner SD. Surgical treatment of constipation and fecal incontinence [J]. Gastroenterol Clin North Am, 2001, 30(1): 131-166.
37
Meehan JJ, Hardin WDJr, Georgeson KE. Gluteus maximus augmentation for the treatment of fecal incontinence [J]. J Pediatr Surg, 1997, 32(7): 1045-1047; discussion 1047-1048.
38
Sielezneff I, Malouf AJ, Bartolo DC, et al. Dynamic graciloplasty in the treatment of patients with faecal incontinence [J]. Br J Surg, 1999, 86(1): 61-65.
39
Matzel KE, Madoff RD, LaFontaine LJ, et al. Complications of dynamic graciloplasty: incidence, management, and impact on outcome [J]. Dis Colon Rectum, 2001, 44(10): 1427-1435.
40
Hassan MZ, Rathnayaka MM, Deen KI. Modified dynamic gracilis neosphincter for fecal incontinence: an analysis of functional outcome at a single institution [J]. World J Surg, 2010, 34(7):1641-1647.
41
董青军, 等. 大便失禁的诊治策略 [J]. 中国医药导报, 2018, 15(24): 26-29.
42
van der Wilt AA, Breukink SO, Sturkenboom R, et al. The artificial bowel sphincter in the treatment of fecal incontinence, long-term complications [J]. Dis Colon Rectum, 2020, 63(8): 1134-1141.
43
苗为民, 曹冬兴, 叶光耀, 等. 大便失禁的外科治疗技术研究进展 [J]. 结直肠肛门外科, 2021, 27(5): 428-431.
44
Christiansen J, Lorentzen M. Implantation of artificial sphincter for anal incontinence [J]. Lancet, 1987, 2(8553): 244-245.
45
Ratto C, Donisi L, Litta F, et al. Implantation of SphinKeeper(TM): a new artificial anal sphincter [J]. Tech Coloproctol, 2016, 20(1): 59-66.
46
Devesa JM, Rey A, Hervas PL, et al. Artificial anal sphincter: complications and functional results of a large personal series [J]. Dis Colon Rectum, 2002, 45(9): 1154-1163.
47
Mantoo S, Meurette G, Podevin J, et al. The magnetic anal sphincter: a new device in the management of severe fecal incontinence [J]. Expert Rev Med Devices, 2012, 9(5): 483-490.
48
Lehur PA, McNevin S, Buntzen S, et al. Magnetic anal sphincter augmentation for the treatment of fecal incontinence: a preliminary report from a feasibility study [J]. Dis Colon Rectum, 2010, 53(12): 1604-1610.
49
Wong MT, Meurette G, Stangherlin P, et al. The magnetic anal sphincter versus the artificial bowel sphincter: a comparison of 2 treatments for fecal incontinence [J]. Dis Colon Rectum, 2011, 54(7): 773-779.
50
Paquette IM, Varma MG, Kaiser AM, et al. The american society of colon and rectal surgeons' clinical practice guideline for the treatment of fecal incontinence [J]. Dis Colon Rectum, 2015, 58(7): 623-636.
51
Shafik A. Polytetrafluoroethylene injection for the treatment of partial fecal incontinence [J]. Int Surg, 1993, 78(2): 159-161.
52
Rosato G, Piccinini P, Oliveira L, et al. Initial results of a new bulking agent for fecal incontinence: a multicenter study [J]. Dis Colon Rectum, 2015, 58(2): 241-246.
53
Matzel KE, Stadelmaier U, Hohenfellner M, et al. Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence [J]. Lancet, 1995, 346(8983): 1124-1127.
54
Ratto C, Litta F, Parello A, et al. Sacral nerve stimulation in faecal incontinence associated with an anal sphincter lesion: a systematic review [J]. Colorectal Dis, 2012, 14(6): e297-e304.
55
Thin NN, Horrocks EJ, Hotouras A, et al. Systematic review of the clinical effectiveness of neuromodulation in the treatment of faecal incontinence [J]. Br J Surg, 2013, 100(11): 1430-1447.
56
陆立, 苏丹, 李丽, 等. 骶神经调节术治疗大便失禁的研究进展 [J]. 结直肠肛门外科, 2021, 27(5): 435-437.
57
Altomare DF, Giuratrabocchetta S, Knowles CH, et al. Long-term outcomes of sacral nerve stimulation for faecal incontinence [J]. Br J Surg, 2015, 102(4): 407-415.
58
Janssen PT, Kuiper SZ, Stassen LP, et al. Fecal incontinence treated by sacral neuromodulation: long-term follow-up of 325 patients [J]. Surgery, 2017, 161(4): 1040-1048.
59
Ratto C, Litta F, Parello A, et al. Sacral nerve stimulation is a valid approach in fecal incontinence due to sphincter lesions when compared to sphincter repair [J]. Dis Colon Rectum, 2010, 53(3): 264-272.
60
Rodrigues FG, Chadi SA, Cracco AJ, et al. Faecal incontinence in patients with a sphincter defect: comparison of sphincteroplasty and sacral nerve stimulation [J]. Colorectal Dis, 2017, 19(5): 456-461.
61
Duelund-Jakobsen J, Lehur PA, Lundby L, et al. Sacral nerve stimulation for faecal incontinence - efficacy confirmed from a two-centre prospectively maintained database [J]. Int J Colorectal Dis, 2016, 31(2): 421-428.
62
Crites-Bachert M, Clark C. Needle placement: a guide to predictable sensory and motor responses based on variations in needle placement during sacral neuromodulation procedures [J]. Int Neurourol J, 2019, 23(4): 302-309.
63
Lorenzi B, Pessina F, Lorenzoni P, et al. Treatment of experimental injury of anal sphincters with primary surgical repair and injection of bone marrow-derived mesenchymal stem cells [J]. Dis Colon Rectum, 2008, 51(4): 411-420.
64
陈正鑫, 樊志敏, 何蕾, 等. 大便失禁新疗法的应用现状 [J]. 中国中西医结合消化杂志, 2019, 27(12): 952-955, 961.
65
Boyer O, Bridoux V, Giverne C, et al. Autologous myoblasts for the treatment of fecal incontinence: results of a phase 2 randomized placebo-controlled study (MIAS) [J]. Ann Surg, 2018, 267(3): 443-450.
66
Tan EK, Vaizey C, Cornish J, et al. Surgical strategies for faecal incontinence--a decision analysis between dynamic graciloplasty, artificial bowel sphincter and end stoma [J]. Colorectal Dis, 2008, 10(6): 577-586.
[1] 中华医学会骨科学分会关节外科学组, 广东省医学会骨质疏松和骨矿盐疾病分会, 广东省佛山市顺德区第三人民医院. 中国髋部脆性骨折术后抗骨质疏松药物临床干预指南(2023年版)[J]. 中华关节外科杂志(电子版), 2023, 17(06): 751-764.
[2] 许正文, 李振, 侯振扬, 苏长征, 朱彪. 富血小板血浆联合植骨治疗早期非创伤性股骨头坏死[J]. 中华关节外科杂志(电子版), 2023, 17(06): 773-779.
[3] 李培杰, 乔永杰, 张浩强, 曾健康, 谭飞, 李嘉欢, 王静, 周胜虎. 细菌培养阴性的假体周围感染诊治的最新进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 827-833.
[4] 张伟. 牙及牙槽外科:舒适治疗的先锋[J]. 中华口腔医学研究杂志(电子版), 2023, 17(06): 386-388.
[5] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[6] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[7] 魏小勇. 原发性肝癌转化治疗焦点问题探讨[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 602-607.
[8] 张其坤, 商福超, 李琪, 栗光明, 王孟龙. 联合脾切除对肝癌合并门静脉高压症患者根治性切除术后的生存获益分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 613-618.
[9] 中国医师协会结直肠肿瘤专业委员会, 中国抗癌协会大肠癌专业委员会, 北京整合医学学会结直肠肿瘤分会. 吲哚菁绿近红外荧光血管成像技术应用于腹腔镜结直肠手术中吻合口血供判断中国专家共识(2023版)[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 441-447.
[10] 薛念余, 张盛敏, 吴凌恒, 沙蕾, 童揽月, 沈崔琴, 李朝军, 杜联芳. 研究血清胆红素对2型糖尿病患者心脏结构发生改变前心肌功能的影响[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1004-1009.
[11] 陆志峰, 周佳佳, 梁舒. 虚拟现实技术在治疗弱视中的临床应用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 891-895.
[12] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[13] 岳瑞雪, 孔令欣, 郝鑫, 杨进强, 韩猛, 崔国忠, 王建军, 张志生, 孔凡庭, 张维, 何文博, 李现桥, 周新平, 徐东宏, 胡崇珠. 乳腺癌HER2蛋白表达水平预测新辅助治疗疗效的真实世界研究[J]. 中华临床医师杂志(电子版), 2023, 17(07): 765-770.
[14] 李变, 王莉娜, 桑田, 李珊, 杜雪燕, 李春华, 张兴云, 管巧, 王颖, 冯琪, 蒙景雯. 亚低温技术治疗缺氧缺血性脑病新生儿的临床分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 639-643.
[15] 戴俊, 李硕, 曹影, 汪守峰, 宋红毛, 蔡菁菁, 邵敏, 陈莉, 程雷, 怀德. 鼻内镜下改良高选择性翼管神经低温等离子消融术对中重度变应性鼻炎的效果研究[J]. 中华临床医师杂志(电子版), 2023, 17(06): 689-693.
阅读次数
全文


摘要