排粪失禁的治疗现状

Current status of the treatments of fecal incontinence

排粪失禁较为常见，严重影响患者生活质量。在过去的二十年中，以治疗和减少并发症为目的的新疗法得到了一定发展。目前常用的非手术疗法包括饮食调节、药物治疗、生物反馈治疗，手术疗法包括修补术（括约肌成形术）、神经刺激疗法（骶前神经刺激等）、人工肛门括约肌替代或者自体肌肉转移术，以及排粪转流造口术。尚属起步阶段，仍存有争议的治疗手段包括射频能量疗法和注射疗法，因其创伤更小，可作为某些轻症排粪失禁患者的非手术治疗选择。医生应综合考虑肛门功能、生活质量及潜在并发症，制定个体化的治疗方案。对于重症排粪失禁患者应谨慎选择创伤较大的手术疗法。本文重点就目前排粪失禁各种治疗方法的选择策略及疗效进行系统回顾和总结。

Fecal incontinence is common. It may have dramatic negative impacts on patients′ quality of life. During the past two decades, new treatments with effective outcomes and less complications have been developed. Non-operative treatments include dietary modifications, medications, and biofeedback therapy. Operative treatments include repair （sphincteroplasty）, stimulation （sacral nerve stimulation）, artificial bowel sphincter implantation, muscle transposition and fecal diversion. The latest reported treatments such as radiofrequency energy delivery and injectable materials are still controversial. But those therapies, having a minimal invasive profile, may be the options before considering a surgery in some patients with mild fecal incontinence. In general, physicians have to make an individualized choice of treatment considering anal function, the quality of life and potential complications. A more invasive operative treatment must be seriously selected in patients with severe fecal incontinence.Indications, outcomes and strategy of current treatments forfecal incontinence are sufficiently discussed by authors in thisarticle.