本邦における便失禁診療の実態調査報告―仙骨神経刺激療法の適応に関する検討
目的：多施設共同による本邦における便失禁診療実態調査に伴って，仙骨神経刺激療法（sacral nerve stimulation，以下SNS）の適応に関して検討した．方法：2009年の1年間に便失禁を主訴に9施設を初診した患者を対象に， SNSの適応に関して調査した．結果：対象症例は293例で，女性214例，初診時平均年齢65歳であった．266例（91％）に何らかの治療が行われ，症状改善率44～93％と，ある程度良好な成績をおさめていた．しかしそれでもSNSの適応に関して，「良い適応」8例，「適応になるかも知れない」73例と合計81例（28％）に，更なる治療としてSNSの適応ありとされていた．...
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| Published in | 日本大腸肛門病学会雑誌 Vol. 65; no. 3; pp. 109 - 117 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本大腸肛門病学会
2012
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0047-1801 1882-9619 |
| DOI | 10.3862/jcoloproctology.65.109 |
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| Abstract | 目的：多施設共同による本邦における便失禁診療実態調査に伴って，仙骨神経刺激療法（sacral nerve stimulation，以下SNS）の適応に関して検討した．方法：2009年の1年間に便失禁を主訴に9施設を初診した患者を対象に， SNSの適応に関して調査した．結果：対象症例は293例で，女性214例，初診時平均年齢65歳であった．266例（91％）に何らかの治療が行われ，症状改善率44～93％と，ある程度良好な成績をおさめていた．しかしそれでもSNSの適応に関して，「良い適応」8例，「適応になるかも知れない」73例と合計81例（28％）に，更なる治療としてSNSの適応ありとされていた．適応ありとした理由は，「現在の治療法では症状の改善が不十分だから」が47％，「SNSの効果に期待するから」が38％であった．結語：多くの症例に検査や治療が行われていたが，症状改善が不十分でSNSの効果に期待する症例が28％いた．今後，本邦へのSNSの導入・普及によって便失禁治療の選択肢が拡がることを期待する． |
|---|---|
| AbstractList | 目的：多施設共同による本邦における便失禁診療実態調査に伴って，仙骨神経刺激療法（sacral nerve stimulation，以下SNS）の適応に関して検討した．方法：2009年の1年間に便失禁を主訴に9施設を初診した患者を対象に， SNSの適応に関して調査した．結果：対象症例は293例で，女性214例，初診時平均年齢65歳であった．266例（91％）に何らかの治療が行われ，症状改善率44～93％と，ある程度良好な成績をおさめていた．しかしそれでもSNSの適応に関して，「良い適応」8例，「適応になるかも知れない」73例と合計81例（28％）に，更なる治療としてSNSの適応ありとされていた．適応ありとした理由は，「現在の治療法では症状の改善が不十分だから」が47％，「SNSの効果に期待するから」が38％であった．結語：多くの症例に検査や治療が行われていたが，症状改善が不十分でSNSの効果に期待する症例が28％いた．今後，本邦へのSNSの導入・普及によって便失禁治療の選択肢が拡がることを期待する． |
| Author | 遠藤, 智美 積, 美保子 山名, 哲郎 勝野, 秀稔 高尾, 良彦 松岡, 弘芳 大毛, 宏喜 吉岡, 和彦 前田, 耕太郎 角田, 明良 貞廣, 荘太郎 味村, 俊樹 |
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| References | 3) 安部達也, 國本正雄, 鉢呂芳一:便失禁専門外来の試み. 日本大腸肛門病会誌 61:247-253, 2008 12) Melenhorst J, Koch SM, Uludag O, et al: Sacral neuromodulation in patients with faecal incontinence: results of the first 100 permanent implantations. Colorect Dis 9:725-730, 2007 17) Chan MK, Tjandra JJ: Sacral nerve stimulation for fecal incontinence: external anal sphincter defect vs. intact anal sphincter. Dis Colon Rectum 51:1015-1024, 2008 27) Kenefick NJ, Emmanuel A, Nicholls RJ, et al: Effect of sacral nerve stimulation on autonomic nerve function. Br J Surg 90:1256-1260, 2003 15) Altomare DF, Ratto C, Ganio E, et al: Long-term outcome of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 52:11-17, 2009 28) Braun PM, Baezner H, Seif C, et al: Alterations of cortical electrical activity in patients with sacral neuromodulator. Eur Urol 41:562-566, 2002 23) Gstaltner K, Rosen H, Hufgard J, et al: Sacral nerve stimulation as an option for the treatment of faecal incontinence in patients suffering from cauda equina syndrome. Spinal Cord 46:644-647, 2008 25) Madoff RD, Laurberg S, Matzel KE, et al: Surgery for Faecal Incontinence. In Abrams P, Cardozo L, Khoury S et al eds. Incontinence 4th ed. Paris, Health Publication Ltd, 2009, 1387-1417 19) Miguel MD, Oteiza F, Ciga MA: Sacral nerve stimulation for the treatment of faecal incontinence following low anterior resection for rectal cancer. Colorectal Dis 13: 72-77, 2010 2) 山名哲郎, 高橋知子, 積美保子ほか:II. 便失禁患者の診療の現状. 日本大腸肛門病会誌 60:895-900, 2007 24) Madoff RD, Pemberton JH, Mimura T, et al: Surgery for Faecal Incontinence. In Abrams P, Cardozo L, Khoury S et al eds. Incontinence 3rd ed. Paris. Health Publication Ltd, 2005, p1565-1588 14) Tjandra JJ, Chan MK, Yeh CH, et al: Sacral nerve stimulation is more effective than optimal medical therapy for severe fecal incontinence: a randomized, controlled study. Dis Colon Rectum 51:494-502, 2008 5) Wexner SD, Coller JA, Devroede G, et al: Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Annals of Surgery 251:441-449, 2010 6) 味村俊樹:便失禁の病態と論理的治療. 消化器内科 52:275-284, 2011. 11) Mowatt G, Glazener C, Jarrett M, et al: Sacral nerve stimulation for fecal incontinence and constipation in adults: a short version Cochrane review. Neurourol Urodyn 27:155-161, 2008 16) Pettit P: Current opinion: complications and troubleshooting of sacral neuromodulation. Int Urogynecol J 21 Suppl 2:S491-S496, 2010 20) Jarrett ME, Matzel KE, Stosser M, et al: Sacral nerve stimulation for fecal incontinence following surgery for rectal prolapse repair: a multicenter study. Dis Colon Rectum 48:1243-1248, 2005 1) Crowell MD, Schettler VA, Lacy BE, et al: Impact of anal incontinence on psychosocial function and health-related quality of life. Dig Dis Sci 52:1627-1631, 2007 8) Thon WF, Baskin LS, Jonas U, et al: Neuromodulation of voiding dysfunction and pelvic pain. World J Urol 9:138-141, 1991 21) Jarrett ME, Matzel KE, Christiansen J, et al: Sacral nerve stimulation for faecal incontinence in patients with previous partial spinal injury including disc prolapse. Br J Surg 92:734-739, 2005 18) Jarrett ME, Dudding TC, Nicholls RJ, et al: Sacral nerve stimulation for fecal incontinence related to obstetric anal sphincter damage. Dis Colon Rectum 51:531-537, 2008 22) Lombardi G, Del Popolo G, Cecconi F, et al: Clinical outcome of sacral neuromodulation in incomplete spinal cord-injured patients suffering from neurogenic bowel dysfunctions. Spinal Cord 48:154-159, 2010 26) 味村俊樹:第4回国際尿失禁会議からの報告 Committee17 Surgery for Faecal Incontinence 「便失禁に対する外科的療法」. 排尿障害プラクティス 18:381-388, 2010 10) Jarrett ME, Mowatt G, Glazener CM, et al: Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg 91:1559-1569, 2004 7) 味村俊樹, 山名哲郎, 高尾良彦ほか. 本邦における便失禁診療の実態調査報告―診断と治療の現状―. 日本大腸肛門病会誌 65:101-108, 2012 9) Matzel KE, Stadelmaier U, Hohenfellner M, et al: Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346:1124-1127, 1995 4) 吉岡和彦, 岩本慈能, 徳原克治ほか:便失禁は稀な疾患か？:当施設における便失禁患者に対する診療の検討. 日本大腸肛門病会誌 63:51-55, 2010 29) Hetzer FH, Bieler A, Hahnloser D, et al: Outcome and cost analysis of sacral nerve stimulation for faecal incontinence. Br J Surg 93:1411-1417, 2006 30) Dudding TC, Pares D, Vaizey CJ, et al: Sacral nerve stimulation for the treatment of faecal incontinence related to dysfunction of the internal anal sphincter. Int J Colorect Dis 25:625-630, 2010 13) Leroi AM, Parc Y, Lehur PA, et al: Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study. Ann Surg 242:662-669, 2005 |
| References_xml | – reference: 25) Madoff RD, Laurberg S, Matzel KE, et al: Surgery for Faecal Incontinence. In Abrams P, Cardozo L, Khoury S et al eds. Incontinence 4th ed. Paris, Health Publication Ltd, 2009, 1387-1417 – reference: 27) Kenefick NJ, Emmanuel A, Nicholls RJ, et al: Effect of sacral nerve stimulation on autonomic nerve function. Br J Surg 90:1256-1260, 2003 – reference: 18) Jarrett ME, Dudding TC, Nicholls RJ, et al: Sacral nerve stimulation for fecal incontinence related to obstetric anal sphincter damage. Dis Colon Rectum 51:531-537, 2008 – reference: 21) Jarrett ME, Matzel KE, Christiansen J, et al: Sacral nerve stimulation for faecal incontinence in patients with previous partial spinal injury including disc prolapse. Br J Surg 92:734-739, 2005 – reference: 5) Wexner SD, Coller JA, Devroede G, et al: Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Annals of Surgery 251:441-449, 2010 – reference: 8) Thon WF, Baskin LS, Jonas U, et al: Neuromodulation of voiding dysfunction and pelvic pain. World J Urol 9:138-141, 1991 – reference: 15) Altomare DF, Ratto C, Ganio E, et al: Long-term outcome of sacral nerve stimulation for fecal incontinence. Dis Colon Rectum 52:11-17, 2009 – reference: 20) Jarrett ME, Matzel KE, Stosser M, et al: Sacral nerve stimulation for fecal incontinence following surgery for rectal prolapse repair: a multicenter study. Dis Colon Rectum 48:1243-1248, 2005 – reference: 30) Dudding TC, Pares D, Vaizey CJ, et al: Sacral nerve stimulation for the treatment of faecal incontinence related to dysfunction of the internal anal sphincter. Int J Colorect Dis 25:625-630, 2010 – reference: 10) Jarrett ME, Mowatt G, Glazener CM, et al: Systematic review of sacral nerve stimulation for faecal incontinence and constipation. Br J Surg 91:1559-1569, 2004 – reference: 28) Braun PM, Baezner H, Seif C, et al: Alterations of cortical electrical activity in patients with sacral neuromodulator. Eur Urol 41:562-566, 2002 – reference: 29) Hetzer FH, Bieler A, Hahnloser D, et al: Outcome and cost analysis of sacral nerve stimulation for faecal incontinence. Br J Surg 93:1411-1417, 2006 – reference: 13) Leroi AM, Parc Y, Lehur PA, et al: Efficacy of sacral nerve stimulation for fecal incontinence: results of a multicenter double-blind crossover study. Ann Surg 242:662-669, 2005 – reference: 3) 安部達也, 國本正雄, 鉢呂芳一:便失禁専門外来の試み. 日本大腸肛門病会誌 61:247-253, 2008 – reference: 7) 味村俊樹, 山名哲郎, 高尾良彦ほか. 本邦における便失禁診療の実態調査報告―診断と治療の現状―. 日本大腸肛門病会誌 65:101-108, 2012 – reference: 22) Lombardi G, Del Popolo G, Cecconi F, et al: Clinical outcome of sacral neuromodulation in incomplete spinal cord-injured patients suffering from neurogenic bowel dysfunctions. Spinal Cord 48:154-159, 2010 – reference: 14) Tjandra JJ, Chan MK, Yeh CH, et al: Sacral nerve stimulation is more effective than optimal medical therapy for severe fecal incontinence: a randomized, controlled study. Dis Colon Rectum 51:494-502, 2008 – reference: 2) 山名哲郎, 高橋知子, 積美保子ほか:II. 便失禁患者の診療の現状. 日本大腸肛門病会誌 60:895-900, 2007 – reference: 26) 味村俊樹:第4回国際尿失禁会議からの報告 Committee17 Surgery for Faecal Incontinence 「便失禁に対する外科的療法」. 排尿障害プラクティス 18:381-388, 2010 – reference: 11) Mowatt G, Glazener C, Jarrett M, et al: Sacral nerve stimulation for fecal incontinence and constipation in adults: a short version Cochrane review. Neurourol Urodyn 27:155-161, 2008 – reference: 6) 味村俊樹:便失禁の病態と論理的治療. 消化器内科 52:275-284, 2011. – reference: 9) Matzel KE, Stadelmaier U, Hohenfellner M, et al: Electrical stimulation of sacral spinal nerves for treatment of faecal incontinence. Lancet 346:1124-1127, 1995 – reference: 16) Pettit P: Current opinion: complications and troubleshooting of sacral neuromodulation. Int Urogynecol J 21 Suppl 2:S491-S496, 2010 – reference: 4) 吉岡和彦, 岩本慈能, 徳原克治ほか:便失禁は稀な疾患か？:当施設における便失禁患者に対する診療の検討. 日本大腸肛門病会誌 63:51-55, 2010 – reference: 24) Madoff RD, Pemberton JH, Mimura T, et al: Surgery for Faecal Incontinence. In Abrams P, Cardozo L, Khoury S et al eds. Incontinence 3rd ed. Paris. Health Publication Ltd, 2005, p1565-1588 – reference: 17) Chan MK, Tjandra JJ: Sacral nerve stimulation for fecal incontinence: external anal sphincter defect vs. intact anal sphincter. Dis Colon Rectum 51:1015-1024, 2008 – reference: 19) Miguel MD, Oteiza F, Ciga MA: Sacral nerve stimulation for the treatment of faecal incontinence following low anterior resection for rectal cancer. Colorectal Dis 13: 72-77, 2010 – reference: 1) Crowell MD, Schettler VA, Lacy BE, et al: Impact of anal incontinence on psychosocial function and health-related quality of life. Dig Dis Sci 52:1627-1631, 2007 – reference: 12) Melenhorst J, Koch SM, Uludag O, et al: Sacral neuromodulation in patients with faecal incontinence: results of the first 100 permanent implantations. Colorect Dis 9:725-730, 2007 – reference: 23) Gstaltner K, Rosen H, Hufgard J, et al: Sacral nerve stimulation as an option for the treatment of faecal incontinence in patients suffering from cauda equina syndrome. Spinal Cord 46:644-647, 2008 |
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| Snippet | 目的：多施設共同による本邦における便失禁診療実態調査に伴って，仙骨神経刺激療法（sacral nerve stimulation，以下SNS）の適応に関して検討した．方法：2009年の1年... |
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| SubjectTerms | 仙骨神経刺激療法 便失禁 外科的療法 |
| Title | 本邦における便失禁診療の実態調査報告―仙骨神経刺激療法の適応に関する検討 |
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