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1.
Lepistö A Pinta T Kylänpää ML Halmesmäki E Väyrynen T Sariola A Stefanovic V Aitokallio-Tallberg A Ulander VM Molander P Luukkonen P 《Diseases of the colon and rectum》2008,51(4):421-425
Purpose This study was designed to evaluate prospectively the results of the overlap technique in primary sphincter reconstruction
after obstetric tear.
Methods Obstetric tears in 44 women were operated on with primary overlap reconstruction. These women were investigated six to nine
months after the operation. Results were compared with those of a historical control group of 52 women whose obstetric sphincter
rupture had been treated with the end-to-end technique.
Results The overlap group had significantly more incontinence symptoms after delivery and repair of the sphincter tear than before
delivery (P < 0.0001); however, their incontinence symptoms were significantly fewer than those of the end-to-end group (P = 0.004). The prevalence of persistent rupture of the external anal sphincter was significantly lower in the overlap group
(6/44, 13.6 percent) than in the end-to-end group (39/52, 75 percent; P < 0.0001). Internal anal sphincter rupture occurred in 5 patients (11.4 percent) in the overlap group and in 40 patients
(76.9 percent) in the end-to-end group (P < 0.0001).
Conclusions The overlap technique should be adopted as the method of choice for primary sphincter repair after obstetric tear. 相似文献
2.
Bordeianou L Lee KY Rockwood T Baxter NN Lowry A Mellgren A Parker S 《Diseases of the colon and rectum》2008,51(7):1010-1014
Introduction We describe the relationship between anorectal manometry, fecal incontinence severity, and findings at endoanal ultrasound.
Methods A total of 351 women completed the Fecal Incontinence Severity Index, underwent anorectal manometry, and endoanal ultrasound.
Severity index and manometry pressures in 203 women with intact sphincters on ultrasound were compared with pressures in 148
women with sphincter defects. Relationships between resting and squeeze pressures, severity index, and size of sphincter defects
were evaluated.
Results Mean severity index in patients with and without sphincter defect was 35.7 vs. 36.7 (not significant). Worsening index correlated with worsening mean and maximum resting pressure (P < 0.0001). Differences were observed in mean and maximum resting pressure between the patients with and without sphincter
defects (26.6 vs. 37.2, P < 0.0001; 39.4 vs. 51.7, P < 0.001). Resting pressures correlated with the sizes of defect (P < 0.0001).
Conclusions Patients with and without sphincter defects had similar severity scores, but patients with defects had a significant decrease
in resting pressures. Patients with larger sphincter defects had lower severity scores and resting pressures. Until a manometry
cutoff can be set to discriminate between absence and presence of defects, both manometry and ultrasound should be offered
to patients with history of anal trauma.
Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.
Reprints are not available. 相似文献
3.
Abstract
Purpose This study was designed to assess whether preoperative endoanal ultrasound plays a prognostic role in the surgical outcome
of anal fistula.
Methods A retrospective review was conducted at a single institution.
Results Sixty-nine patients underwent 83 studies. Indications for endoanal ultrasound included complex fistulas and tracts, multiple
external openings, recurrent fistulas, and/or failed previous surgical intervention. Mean age was 51.7 years. Fifty-three
patients (77 percent) were men. Mean duration of symptoms was 3.1 years. Forty-nine patients (71 percent) had undergone previous
surgical intervention to eradicate sepsis or fistula. Sixty patients (87 percent) underwent surgical interventions and were
divided into two groups: Group A (73.3 percent), concordance with ultrasound findings; and Group B (26.7 percent), nonconcordance.
Mean follow-up in the surgical group was 15.6 months. Measured outcome was total number of operations per patient and failure
rate of primary surgical intervention. No difference was noted in mean total number of operations between Group A (1.57) and
Group B (1.69) (P = 0.71). There was a statistically nonsignificant trend toward a higher failure rate of the primary intervention in the nonconcordance
group [failure rate 18.2 percent in Group A vs. 25 percent in Group B (P = 0.72)].
Conclusions The findings and accuracy of preoperative endoanal ultrasound did not influence postoperative outcome.
Reprints are not available.
Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007 相似文献
4.
Purpose This prospective study was designed to assess the effectiveness of sacral nerve stimulation for fecal incontinence in patients
with external anal sphincter defect and to evaluate its efficacy regarding presence and size of sphincter defect.
Methods Fifty-three consecutive patients who underwent sacral nerve stimulation for fecal incontinence were divided into two groups:
external anal sphincter defect group (n = 21) vs. intact sphincter group (n = 32). Follow-up was performed at 3, 6, and 12 months with anorectal physiology, Wexner’s score,
bowel diary, and quality of life questionnaires.
Results The external anal sphincter defect group (defect <90°:defect 90°–120° = 11:10) and intact sphincter group were comparable
with regard to age (mean, 63 vs. 63.6) and sex. Incidence of internal anal sphincter defect and pudendal neuropathy was similar. All 53 patients benefited
from sacral nerve stimulation. Weekly incontinent episodes decreased from 13.8 to 5 (P < 0.0001) for patients with external anal sphincter defects and from 6.7 to 2 (P = 0.001) for patients with intact sphincter at 12-month follow-up. Quality of life scores improved in both groups (P < 0.0125). There was no significant difference in improvement in functional outcomes after sacral nerve stimulation between
patients with or without external anal sphincter defects. Clinical benefit of sacral nerve stimulation was similar among patients
with external anal sphincter defects, irrespective of its size. Presence of pudendal neuropathy did not affect outcome of
neurostimulation.
Conclusions Sacral nerve stimulation for fecal incontinence is as effective in patients with external anal sphincter defects as those
with intact sphincter and the result is similar for defect size up to 120° of circumference.
†Deceased. 相似文献
5.
Mazouni C Bretelle F Battar S Bonnier P Gamerre M 《Diseases of the colon and rectum》2005,48(7):1432-1436
PURPOSE This study was designed to evaluate persistent anal symptoms after first instrumental delivery beyond the postpartum period.METHODS This prospective study was performed in a cohort of primiparas who underwent instrumental delivery from January 1, 2001 to September 30, 2002. Questionnaires for anal symptoms were completed in the maternity ward on the day after delivery and by mail or telephone up to 12 months after the end of the inclusion period. Symptoms of fecal incontinence (solid and/or liquid stool) and precursor symptoms (flatus incontinence, soiling, and/or fecal urgency) were recorded.RESULTS Of the 212 females who completed the first questionnaire, 159 (75 percent) responded to the second. Overall, 8.8 percent of females had solid and/or liquid stool incontinence, 7.5 percent had involuntary flatus, 8.2 percent had symptoms of fecal urgency, and 24.5 percent experienced new anal symptoms, Of the five females with third-degree tears, none complained of anal incontinence. The only significant difference in delivery data between females who did and did not develop new anal symptoms was larger fetal head size in the new symptom group (96.4 vs. 93.9 mm, respectively; P < 0.05).CONCLUSIONS Frequency of new anal symptoms other than incontinence beyond postpartum period is underestimated in primiparas after instrumental delivery. Only fetal head size was found to predict occurrence of persistent anal incompetence after instrumental delivery.Reprints are not available. 相似文献
6.
Huebner M Margulies RU Fenner DE Ashton-Miller JA Bitar KN DeLancey JO 《Diseases of the colon and rectum》2007,50(9):1405-1411
Purpose Age can affect the delicate physiologic balance of the internal anal sphincter diameters and pressure governed by Laplace’s
law. This study compares the effect of aging on the internal anal sphincter thickness and diameter in younger and older nulliparous
females without symptoms of fecal incontinence undisturbed by an endoanal probe.
Methods Magnetic resonance images were selected from a large database of nulliparous females to form two groups: “younger” females,
aged 30 years and younger (n = 32), and “older” females, aged 50 years and older (n = 32). All patients were scanned without
endoanal coils to allow undistorted measurement of the internal anal sphincter diameters. Inner and outer diameters were measured
from axial magnetic resonance images and used to calculate sphincter thickness and mean radius by two independent investigators
blinded to patient age.
Results The mean age in the younger group was 26 ± 2.8 years, whereas that of the older group was 61.8 ± 7.6 years. Older females
had a 33 percent thicker internal anal sphincter (younger vs. older: 4.5 ± 0.7 vs. 5.9 ± 1 mm; P < 0.001), a 20 percent larger inner diameter (7.1 ± 1.3 vs. 8.5 ± 1.8 mm; P = 0.001), and a 27 percent larger outer diameter (16 ± 2.1 vs. 20.3 ± 3.3 mm; P < 0.001) than younger females. Neither sphincter thickness nor inner or outer diameter correlated with body mass index.
Conclusions There is an increase in internal anal sphincter thickness, inner diameter, and outer diameter, which correlates with age in
asymptomatic nulliparous females.
Supported by the National Institutes of Health, ORWH & NICHD Sex & Gender Factors Affecting Women’s Health SCOR: P50, and
NICHD R01 HD 044406: NICHD R01 DK 051405, R01 HD 038665; German Research Foundation (DFG, HU1502/1–1).
Presented as a poster at the annual meeting of the American Urogynecologic Society, October 19 to 21, 2006, Palm Springs,
Florida.
Presented as an oral poster at the annual meeting of the International Urogynecological Association, September 6 to 9, 2006,
Athens, Greece.
Presented as an oral poster and oral presentation at the annual meeting of the German Association of Gynecology and Obstetrics,
September 19 to 22, 2006, Berlin, Germany. 相似文献
7.
Purpose This randomized study was designed to compare the effect of sacral neuromodulation with optimal medical therapy in patients
with severe fecal incontinence.
Methods Patients (aged 39–86 years) with severe fecal incontinence were randomized to have sacral nerve stimulation (SNS group; n = 60)
or best supportive therapy (control; n = 60), which consisted of pelvic floor exercises, bulking agent, and dietary manipulation.
Full assessment included endoanal ultrasound, anorectal physiology, two-week bowel diary, and fecal incontinence quality of
life index. The follow-up duration was 12 months.
Results The sacral nerve stimulation group was similar to the control group with regard to gender (F:M = 11:1 vs. 14:1) and age (mean, 63.9 vs. 63 years). The incidence of a defect of ≤ 120° of the external anal sphincter and pudendal neuropathy was similar between
the groups. Trial screening improved incontinent episodes by more than 50 percent in 54 patients (90 percent). Full-stage
sacral nerve stimulation was performed in 53 of these 54 “successful” patients. There were no septic complications. With sacral
nerve stimulation, mean incontinent episodes per week decreased from 9.5 to 3.1 (P < 0.0001) and mean incontinent days per week from 3.3 to 1 (P < 0.0001). Perfect continence was accomplished in 25 patients (47.2 percent). In the sacral nerve stimulation group, there
was a significant (P < 0.0001) improvement in fecal incontinence quality of life index in all four domains. By contrast, there was no significant
improvement in fecal continence and the fecal incontinence quality of life scores in the control group.
Conclusions Sacral neuromodulation significantly improved the outcome in patients with severe fecal incontinence compared with the control
group undergoing optimal medical therapy.
*Deceased.
Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007. 相似文献
8.
Anal sphincter integrity and function influences outcome in rectovaginal fistula repair 总被引:2,自引:3,他引:2
Charles B. S. Tsang M.D. Robert D. Madoff M.D. W. Douglas Wong M.D. David A. Rothenberger M.D. Charles O. Finne M.D. Dr. Daniel Singer Ann C. Lowry M.D. 《Diseases of the colon and rectum》1998,41(9):1141-1146
PURPOSE: Traumatic sphincter disruption frequently is associated with a rectovaginal fistula, but the effect of a persistent sphincter defect on the outcome of rectovaginal fistula repair is poorly documented. We analyzed the outcome of rectovaginal fistula repairs based on preoperative sphincter status. PATIENTS AND METHODS: We identified 52 women who underwent 62 repairs of simple obstetrical rectovaginal fistulas between 1992 and 1995. Fourteen patients (27 percent) had preoperative endoanal ultrasound studies and 25 (48 percent) had anal manometry studies. Follow-up was by mailed questionnaire in 36 patients (69 percent) and by telephone interview in 12 (23 percent), for a total response rate of 92 percent. Median age was 30.5 (range, 18–70) years, and median follow-up was 15 (range, 0.5–123) months. Twenty-five patients (48 percent) complained of varying degrees of fecal incontinence before surgery. There were 27 endorectal advancement flaps and 35 sphincteroplasties (28 with and 8 without levatoroplasty). RESULTS: Success rates were 41 percent with endorectal advancement flaps and 80 percent with sphincteroplasties (96 percent success with and 33 percent without levatoroplasty;P=0.0001). Endorectal advancement flap was successful in 50 percent of patients with normal sphincter function but in only 33 percent of patients with abnormal sphincter function(P=not significant). For sphincteroplasties, success rates were 73vs. 84 percent for normal and abnormal sphincter function, respectively (P=not significant). Results were better after sphincteroplastiesvs. endorectal advancement flaps in patients with sphincter defects identified by endoanal ultrasound (88vs. 33 percent;P=not significant) and by manometry (86vs. 33 percent;P = not significant). Poor results correlated with prior surgery in patients undergoing endorectal advancement flaps (45 percentvs. 25 percent;P = not significant) but not sphincteroplasties (80vs. 75 percent;P = not significant). CONCLUSIONS: All patients with rectovaginal fistula should undergo preoperative evaluation for occult sphincter defects by endoanal ultrasound or anal manometry or both procedures. Local tissues are inadequate for endorectal advancement flap repairs in patients with sphincter defects and a history of previous repairs. Patients with clinical or anatomic sphincter defects should be treated by sphincteroplasty with levatoroplasty.Read at the Minnesota Surgical Society, May 3, 1996, at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1996, and at the Tripartite Meeting, July 8 to 10, 1996. 相似文献
9.
PURPOSE: This study was designed to determine the longterm
outcome of forceps delivery in terms of evidence of
anal sphincter injury and the incidence of fecal and urinary
incontinence. METHODS: Women who delivered in 1964
were evaluated by using endoanal ultrasound, manometry,
and a continence questionnaire. Women delivered by forceps
were matched with the next normal delivery and
elective cesarean delivery in the birth register. RESULTS:
The womens overall obstetric history was evaluated.
Women who had ever had a forceps delivery (n = 42) had
a significantly higher incidence of sphincter rupture compared
with women who had only unassisted vaginal deliveries
(n = 41) and elective cesarean sections (n = 6) (44 vs.
22 vs. 0 percent; chi-squared 7.09; P = 0.03). There was no
significant difference in the incidence of significant fecal
incontinence between the three groups (14 vs. 10 vs. 0
percent) or significant urinary incontinence (7 vs. 19 vs. 0
percent). CONCLUSION: Anal sphincter injury was associated
with forceps delivery in the past; however, significant
fecal and urinary incontinence was not. 相似文献
10.
Siproudhis L Eléouet M Rousselle A El Alaoui M Ropert A Bretagne JF 《Diseases of the colon and rectum》2008,51(9):1356-1360
PURPOSE Rectal prolapse is frequently associated with fecal incontinence; however, the relationship is questionable. The study was
designed to evaluate fecal incontinence in a large consecutive series of patients who suffered from rectal prolapse, focusing
on both past history, anal physiology, and imaging.
METHODS Eighty-eight consecutive patients who suffered from an overt rectal prolapse (72 women, 16 men; mean age, 51.1 ± 19.5 years)
as a main symptom were analyzed; 48 patients also experienced fecal incontinence compared with 40 without incontinence. Logistic
regression analyses were performed.
RESULTS The two groups of patients did not differ with respect to parity, weekly stool frequency, main duration of symptoms before
referral, occurrence of dyschezia, and digital help to defecate. Patients with prolapse who were older than 45 years (odds
ratio (OR), 4.51 (1.49–13.62); P = 0.007) and those with a past history of hemorrhoidectomy (OR, 9.05 (1.68–48.8); P = 0.01) were significantly more incontinent. Incontinent group showed frequent internal anal sphincter defect compared with
the continent group (60 vs. 6.2 percent; P = 0.0018).
CONCLUSIONS In patients with overt rectal prolapse, the occurrence of fecal incontinence needs special consideration for age and previous
hemorrhoid surgery as causative factors. Anal weakness and sphincter defects are frequently observed. 相似文献
11.
Injectable Silicone Biomaterial for Fecal Incontinence Caused by Internal Anal Sphincter Dysfunction Is Effective 总被引:7,自引:6,他引:1
PURPOSE Fecal incontinence caused by a weak or disrupted internal anal sphincter is common but there has been no effective treatment. This prospective study evaluates the medium-term clinical effects of an injectable silicone biomaterial, PTPTM (Bioplastique), used to augment the internal anal sphincter.METHOD Eighty-two patients (64 females; median age, 66 years) with severe fecal incontinence and a low anal resting pressure caused by internal anal sphincter dysfunction (defect, n = 11; intact, n = 71) were randomized to PTPTM injection into intersphincteric space and internal anal sphincter with (Group A, n = 42) or without (Group B, n = 40) guidance by endoanal ultrasound. Both groups were similar in terms of age, gender, past anorectal surgery, duration of follow-up (median, 6 months; range, 1–12 months), and baseline continence score. Sixty-two percent of Group A and 55 percent of Group B had prolonged pudendal nerve terminal motor latency.RESULTS There was no significant complication. Two patients in Group A and four patients in Group B noted minor discomfort at injection sites. At one month postprocedure, endoanal ultrasound confirmed retention of silicone biomaterial without migration. In both groups, fecal continence was significantly improved by PTPTM implants 1 month after injection, but continued to improve significantly for up to 12 months in Group A and 6 months in Group B (P < 0.001). Improvement in fecal continence and maximum anal resting pressure was significantly greater in Group A, in whom injection was guided by endoanal ultrasound, than in Group B. At three months after injection, significantly more Group A patients than Group B patients achieved >50 percent improvement in Wexners continence score (69 percent vs. 40 percent; P = 0.014). Ninety-three percent of Group A and 92 percent of Group B had >50 percent improvement in global quality of life scores (visual analog scale). At a median follow-up of 6 months, all domains of the fecal incontinence quality of life scale improved significantly in both groups; however, the physical function and mental health scores of Short Form-12 only improved in Group A. A prolonged pudendal nerve terminal motor latency had no effect on functional outcome in either group.CONCLUSION Injection of silicone biomaterial provided a marked improvement in fecal continence and quality of life in patients with internal sphincter dysfunction, despite the presence of pudendal neuropathy.Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004. 相似文献
12.
Terra MP Deutekom M Dobben AC Baeten CG Janssen LW Boeckxstaens GE Engel AF Felt-Bersma RJ Slors JF Gerhards MF Bijnen AB Everhardt E Schouten WR Berghmans B Bossuyt PM Stoker J 《International journal of colorectal disease》2008,23(5):503-511
Purpose Pelvic-floor rehabilitation does not provide the same degree of relief in all fecal incontinent patients. We aimed at studying
prospectively the ability of tests to predict the outcome of pelvic-floor rehabilitation in patients with fecal incontinence.
Materials and methods Two hundred fifty consecutive patients (228 women) underwent medical history and a standardized series of tests, including
physical examination, anal manometry, pudendal nerve latency testing, anal sensitivity testing, rectal capacity measurement,
defecography, endoanal sonography, and endoanal magnetic resonance imaging. Subsequently, patients were referred for pelvic-floor
rehabilitation. Outcome of pelvic-floor rehabilitation was quantified by the Vaizey incontinence score. Linear regression
analyses were used to identify candidate predictors and to construct a multivariable prediction model for the posttreatment
Vaizey score.
Results After pelvic-floor rehabilitation, the mean baseline Vaizey score (18, SD ± 3) was reduced with 3.2 points (p < 0.001). In addition to the baseline Vaizey score, three elements from medical history were significantly associated with
the posttreatment Vaizey score (presence of passive incontinence, thin stool consistency, primary repair of a rupture after
vaginal delivery at childbed) (R
2, 0.18). The predictive value was significantly but marginally improved by adding the following test results: perineal and/or
perianal scar tissue (physical examination), and maximal squeeze pressure (anal manometry; R
2, 0.20; p = 0.05).
Conclusion Additional tests have a limited role in predicting success of pelvic-floor rehabilitation in patients with fecal incontinence. 相似文献
13.
Soerensen MM Bek KM Buntzen S Højberg KE Laurberg S 《Diseases of the colon and rectum》2008,51(3):312-317
Purpose Traditionally sphincter repair has not been performed during the puerperium. This prospective study was designed to determine
the long-term outcome of delayed primary or early secondary sphincteroplasty in the puerperium.
Methods Between 1991 and 2005, 22 females underwent delayed primary or early secondary repair after third-degree or fourth-degree
anal sphincter rupture. Delayed primary reconstruction was performed more than 72 hours after delivery. Early secondary reconstruction
was performed within 14 days postpartum. The reconstruction of the anal sphincter was performed without a covering stoma,
in all cases. A control group of 19 age-matched and parity-matched females, without known anal sphincter injury after vaginal
delivery, were included. Current degree of continence and associated quality of life were determined by a fecal incontinence
severity questionnaire and a quality of life questionnaire.
Results None of the females had complications postoperatively. Mean follow-up was 50 (range, 2–155) months in the case group and 60
(range, 12–132) months in the control group. At time of follow-up, the Wexner score was 4.1 (range, 0–13) in females with
delayed primary or early secondary reconstruction and 1.1 (range, 0–8) in the control group (P < 0.01). The inconvenience of incontinence after reconstruction was significantly higher (P < 0.01) compared with the control group, but the quality of life was not significantly affected (P = 0.75).
Conclusions It is safe to perform a delayed primary or early secondary reconstruction without a covering stoma in females who have sustained
a third-degree or fourth-degree obstetric tear. The long-term functional outcome is acceptable.
Poster presentation at the meeting of European Society of Coloproctology (ESCP), Lisbon, Portugal, September 13 to 16, 2006. 相似文献
14.
15.
Purpose This study was designed to assess the safety and efficacy of 0.2 percent glyceryl trinitrate suppository form in the healing
of chronic anal fissure.
Methods Thirty-four patients with symptomatic chronic anal fissures were assigned to 0.2 percent glyceryl trinitrate suppository (n = 21)
or placebo (n = 13) in a double blind design. Patient's symptom scores were registered at first visit. A validated daily chart
was given to assess their symptoms on a daily basis. Both groups received psyllium from the beginning of the study. They were
assessed at two-week intervals for six weeks. Then, they started a washout period of one month and after that were crossed
over for another six weeks. Chi-squared, t-tests, and analysis of variance were used for statistical analysis.
Results Complete healing at six weeks was achieved in 12 of 21 patients (57 percent) in the glyceryl trinitrate group and 5 of 13
patients (38 percent) in the placebo (P < 0.05).The overall healing rates at the end of study were 15 of 21 (71 percent) vs. 11 of 13 (84 percent) in the glyceryl trinitrate and placebo groups, respectively (P > 0.05).
Conclusions Application of 0.2 percent glyceryl trinitrate suppository form represents a new, promising, and effective treatment for chronic
anal fissure.
Supported by Isfahan University of Medical Sciences and Poursina Hakim Research Institute.
Read at the Iranian Congress of Gastroenterology and Hepatology (ICGH 2006), Tehran, Iran. 相似文献
16.
Jarrett ME Dudding TC Nicholls RJ Vaizey CJ Cohen CR Kamm MA 《Diseases of the colon and rectum》2008,51(5):531-537
Purpose Sphincter repair is the standard treatment for fecal incontinence secondary to obstetric external anal sphincter damage; however,
the results of this treatment deteriorate over time. Sacral nerve stimulation has become an established therapy for fecal
incontinence in patients with intact sphincter muscles. This study investigated its efficacy as a treatment for patients with
obstetric-related incontinence.
Methods Fecally incontinent patients with external sphincter defects who would normally have undergone overlapping sphincter repair
as a primary or repeat procedure were included. Eight consecutive women (median age, 46 (range, 35–67) years) completed temporary
screening; all eventually had permanent implantation.
Results Six of eight patients had improved continence at median follow-up of 26.5 (range, 6–40) months. Fecal incontinent episodes
improved from 5.5 (range, 4.5–18) to 1.5 (range, 0–5.5) episodes per week (P = 0.0078). Urgency improved in five patients, with ability to defer defecation improving from a median of <1 (range, 0–5)
minute to 1 to 5 (range, 1 to >15) minutes (P = 0.031, all 8 patients). There was no change in anal manometry or rectal sensation. There was significant improvement in
lifestyle, coping/behavior, depression/self-perception, and embarrassment as measured by the American Society of Colon and
Rectal Surgery fecal incontinence quality of life score.
Conclusions Sacral nerve stimulation is potentially a safe and effective minimally invasive treatment for fecal incontinence in patients
with de novo external anal sphincter defects or defects after unsuccessful previous external anal sphincter repair, although numbers remain
small.
Dr. Michael Kamm is a consultant to and received research support from Medtronic, however, study design, performance, analysis,
and reporting have been conducted without the influence of Medtronic. 相似文献
17.
de Leeuw JW Vierhout ME Struijk PC Auwerda HJ Bac DJ Wallenburg HC 《Diseases of the colon and rectum》2002,45(8):1004-1010
PURPOSE: This study was designed to assess the relationship of anal endosonography and manometry to anorectal complaints in the evaluation of females a long time after vaginal delivery complicated by anal sphincter damage.
METHODS: Thirty-four patients with anal sphincter damage after delivery, 22 with and 12 without anorectal complaints, and 12 controls without anorectal complaints underwent anal endosonography, manometry, and rectal sensitivity testing. Complaints were assessed by questionnaire, with a median follow-up of 19 years.
RESULTS: Median maximum anal resting pressures were significantly lower in patients with anal sphincter damage with complaints (31 mmHg) than in controls (52 mmHg; P < 0.001). Median maximum anal squeeze pressures were significantly lower in patients with (55 mmHg) and without (69 mmHg) complaints than in controls (112 mmHg; P < 0.001 for both). Maximum anal resting pressures were significantly lower in patients with anorectal complaints after anal sphincter damage than in patients without complaints (P = 0.02). Results of anal manometry showed a large overlap between all groups. Rectal sensitivity showed no significant differences between the three groups. Persisting sphincter defects, shown by anal endosonography, were significantly more present in patients with anal sphincter damage after delivery with (86 percent) and without (67 percent) complaints than in controls (8 percent; P < 0.001 and P < 0.01, respectively). No differences in the number of echocardiographically proven sphincter defects were found between patients with or without anorectal complaints after anal sphincter damage
CONCLUSIONS: Echographically proven sphincter defects are strongly associated with a history of anal sphincter damage during delivery. Sphincter defects are present in the majority of patients with anorectal complaints. Anal manometry provides little additional therapeutic information when performed after anal endosonography in patients with anorectal complaints after anal sphincter damage during delivery. 相似文献
18.
Aarti Varma M.B. Ch.B. James Gunn Angela Gardiner B.Sc. Stephen W. Lindow Mr. Graeme S. Duthie M.D. 《Diseases of the colon and rectum》1999,42(12):1537-1542
PURPOSE: An obstetrically damaged anal sphincter is the principal cause of the development of fecal incontinence in otherwise healthy females. Reports suggest that such damage complicates as many as 35 percent of primiparous vaginal deliveries, with 13 percent of first-time mothers becoming symptomatic. In maternity units delivering 3,000 patients annually, it would follow that 390 symptomatic patients would develop new symptoms each year. This incidence of dysfunction does not reflect current clinical practice. We have investigated this discrepancy to establish the actual incidence of anal sphincter trauma associated with childbirth. METHODS: During a six-week period, 159 females (105 primiparous and 54 para-I) were prospectively assessed postnatally using a standardized symptom questionnaire, endoanal ultrasound, and anal manometry. This group constituted 84 percent of all eligible deliveries occurring in the unit during the study period. RESULTS: One patient developed fecal urgency after this delivery; there were no reports of fecal incontinence. Anal sphincter injuries were identified ultrasonically in 6.8 percent of primiparous patients, 12.2 percent of para-I patients having vaginal deliveries, and 83 percent of patients having forceps deliveries overall. Manometric data provided confirmatory evidence, with significantly reduced maximum squeeze pressures in patients with a disrupted anal sphincter (P<0.0005). CONCLUSIONS: A symptom questionnaire is inadequate to identify anal sphincter injuries. The incidence of sphincter injury in relation to vaginal delivery has been overestimated in previous published work. This study demonstrates that the true incidence is 8.7 percent overall and that symptoms of sphincter dysfunction are uncommon—this is in keeping with current clinical practice. 相似文献
19.
Roohipour R Patil S Goodman KA Minsky BD Wong WD Guillem JG Paty PB Weiser MR Neuman HB Shia J Schrag D Temple LK 《Diseases of the colon and rectum》2008,51(2):147-153
Purpose The incidence of anal canal squamous-cell carcinoma is increasing. Limited data exist on predictors of treatment failure.
This study was designed to identify predictors for relapse/persistence after first-line therapy.
Methods Using one database, we identified 131 Stages I-III patients treated for primary anal canal squamous-cell carcinoma at our
institution from December 1986 to August 2006, with minimum six-month follow-up. Demographic, pathologic, treatment, and outcome
data were extracted. Treatment failure was defined as biopsy-proven persistence or relapse (local and/or distant). Univariate,
bivariate, and multivariate survival analyses were performed.
Results Of 131 patients (median age, 58.3 years; median follow-up, 2.9 (range, 0.6–11.2) years), 66 percent were females, 43.5 percent
were Stage II, and 11 (8 percent) were HIV-positive. Surgery only (local excision) was uncommon (6.9 percent, n = 9). One
hundred twenty-two patients (93.1 percent) received radiotherapy; two required preradiotherapy diversion. Although 114 (93.4
percent) completed radiotherapy, most required treatment breaks, making total duration of radiotherapy longer than planned.
Almost all patients undergoing radiotherapy (96.7 percent, 118/122) also had chemotherapy: 118 (100 percent, Stages I-III)
had concurrent chemotherapy: (98 (83.8 percent) mitomycin/5-fluorouracil, 12 (10.2 percent) cisplatin/5-fluorouracil, 8 (6.8
percent) 5-fluorouracil alone); 35 of 46 (76 percent) Stage III patients received induction chemotherapy (34 (97.1 percent)
cisplatin/5-fluorouracil, 1 (2.8 percent) 5-fluorouracil alone). Many (44 percent Stages I/II, 48.9 percent Stage III) required
dose adjustments. Thirty-seven patients (28.2 percent) failed first-line therapy. There were no differences between patients
with relapse (n = 22) or persistence (n = 15) of disease. Bivariate analyses demonstrated that T stage (P = 0.0019), completion of radiotherapy, and total radiotherapy dose (P = 0.03) were all significantly associated with treatment failure. On multivariate analyses, disease stage (P = 0.05) and completion of radiotherapy (P = 0.01) remained significant predictors of relapse-free survival.
Conclusions Tolerance of chemoradiation seems to be an important predictor of treatment success. Effective therapies with less acute toxicity
must be identified.
Dr. Temple is funded by the Society of University Surgeons and by the American Society of Clinical Oncology.
Read at the meeting of The American Society of Colon and Rectal Surgeons, June 2 to 6, 2007.
No reprints available.
An erratum to this article can be found at 相似文献
20.
The Effect of Restorative Proctocolectomy on Sexual Function,Urinary Function,Fertility, Pregnancy and Delivery: A Systematic Review 总被引:3,自引:0,他引:3
Cornish JA Tan E Teare J Teoh TG Rai R Darzi AW Paraskevas P Clark SK Tekkis PP 《Diseases of the colon and rectum》2007,50(8):1128-1138
Purpose This study was designed to evaluate the effect of restorative proctocolectomy on sexual function, urinary function, fertility,
pregnancy, and delivery in patients with ulcerative colitis.
Methods A systematic literature search was performed of articles published between 1980 and 2005 on patients undergoing restorative
proctocolectomy for ulcerative colitis reporting data on the outcomes of interest. A random-effect, meta-analytical model
was used for pooled estimates and 95 percent confidence intervals.
Results A total of 22 studies, with 1,852 females, were included. Infertility rate was 12 percent before restorative proctocolectomy
and 26 percent after, among 945 patients in seven studies. The incidence of sexual dysfunction was 8 percent preoperatively
and 25 percent postoperatively (7 studies, n = 419). Two studies (n = 62) reported no urinary dysfunction in patients undergoing
restorative proctocolectomy. There was an increased incidence of cesarean section after restorative proctocolectomy. During
the third trimester of pregnancy, there was an increase in stool frequency by 1.15 stools per day compared with before pregnancy
frequency (n = 49 95 percent confidence interval, 0.28–2.03 P = 0.01 chi-squared statistic, 0.04 P = 0.84). No significant differences were seen in pouch function after vaginal delivery (n = 456; weighted mean difference,
0.23; 95 percent confidence interval, 0.43–0.88; P = 0.49; chi-squared statistic, 1.29; P = 0.26).
Conclusions The incidence of dyspareunia increases after restorative proctocolectomy. There was a decrease in fertility after restorative
proctocolectomy. Pregnancy after restorative proctocolectomy was not associated with an increase in complications. There was
an increase in stool frequency and pad usage during the third trimester. Vaginal delivery is safe after restorative proctocolectomy.
Pouch function after delivery returns to pregestational function within six months. 相似文献