生物反馈联合电刺激治疗小儿充溢性大便失禁的疗效观察

Efficiency of overflow fecal incontinence treated by biofeedback and electrical-stimulating therapy

目的:探讨生物反馈联合电刺激治疗小儿充溢性大便失禁的近期疗效。方法:应用生物反馈电刺激仪,对20例充溢性大便失禁患儿进行综合治疗(实验组),包括功能性大便失禁患儿10例(A组),神经源性大便失禁10例(B组),治疗时间20～30min,每周治疗5次,20次为1个疗程。另选10例脊髓栓系松解术后引起的充溢性大便失禁患儿仅行盆底肌训练作为对照组(C组)。治疗前后均行临床失禁程度分级,肛门直肠测压及盆底肌电图检查。结果:随访3～5年,平均4.5年。A、B2组患儿治疗后临床评分4.8±0.6,3.4±0.5;肛门最大收缩压(187.5±5.5)mmHg,(130.8±3.9)mmHg;持续收缩时间(9.3±1.3)s,(5.1±1.2)s;直肠感觉阈值(23.5±5.7)mL,(34.9±3.9)mL;肛门外括约肌收缩振幅(286.6±58.3)μV,(228.5±33.1)μV;阴部神经潜伏期(34.8±10.5)ms,(47.4±8.0)ms,与治疗前比较差异均有统计学意义(P<0.05),功能性大便失禁患儿疗效优于神经源性大便失禁患儿,神经源性综合训练组优于神经源性对照组(P<0.05)。结论:生物反馈联合电刺激训练是治疗充溢性大便失禁一种可以选择的有效方法。

Objective： To investigate the shortterm efficiency of overflow fecal incontinence treated by biofeedback and electrical stimulating therapy. Methods： Twenty children with overflow fecal incontinence were given combined therapy, biofeedback and electricalstimulating therapy,for four weeks. Every therapy cost 20 to 30 minutes. The grading of clinical incontinence degree ,measurement of pressure of the anus and rectum, electromyogram of muscles of solum plevis were done before and after the therapy. Results： Follow-up was done for a mean of 4.5 years （range 3 to 5）, the subjective scores, maximum contractive pressure of anus, last contractive time, rectal volume at sensory threshold, contraction amplitude of external anal sphincter and pudenda neural latency were significantly different from the ones before treatment （P〈0.05）, the therapeutic efficacy of functional fecal incontinence were better than that of the neurogenic fecal incontinence, simultaneously, the effect of neurogenic fecal incontinence, surpassed the control group ones. Conclusion： Biofeedback and electrical-stimulating therapy is a possible effective method in overflow fecal incontinence children.