A systematic review of the literature reporting on randomised controlled trials comparing treatments for faecal incontinence in adults

<b>Aim:</b> To perform a review of the literature reporting on randomised controlled trials (RCTs) comparing treatments for faecal incontinence (FI) in adults. <b>Methods:</b> A literature search of MEDLINE, Embase, Science Citation Index Expanded and Cochrane was performed in order to identify RCTs reporting on treatments for FI. <b>Results:</b> The review included 60 RCTs reporting on 4838 patients with a mean age ranging from 36.8 to 88 years. From the included RCTs, 32 did not identify a significant difference between the treatments compared. Contradictory results were identified in RCTs comparing percutaneous posterior tibial nerve stimulation and transcutaneous tibial nerve stimulation versus sham stimulation, biofeedback-pelvic floor muscle training (BF-PFMT) versus PFMT, and between bulking agents such as PTQ^TM versus Durasphere^®. In two separate RCTs, combination treatment of amplitude-modulated medium frequency stimulation and electromyography-biofeedback (EMG-BF), was noted to be superior to EMG-BF and low-frequency electrical stimulation alone. Combination of non-surgical treatments such as BF with sphincteroplasty significantly improved continence scores compared to sphincteroplasty alone. Surgical treatments were associated with higher rates of serious adverse events compared to non-surgical interventions. <b>Conclusions:</b> The current evidence has not identified significant differences between treatments for FI, and where differences were identified, the results were contradictory between RCTs.

**研究目的：** 本研究旨在系统回顾针对成人大便失禁（faecal incontinence, FI）治疗方案的随机对照试验（randomised controlled trials, RCTs）相关文献。**研究方法：** 通过检索MEDLINE、Embase、科学引文索引扩展版（Science Citation Index Expanded）及Cochrane图书馆数据库，以筛选报道大便失禁治疗方案的随机对照试验。**研究结果：** 本综述共纳入60项随机对照试验，涉及4838例患者，患者平均年龄介于36.8岁至88岁之间。其中32项试验未观察到所比较的治疗方案间存在显著差异。在比较经皮胫后神经刺激、经皮胫神经刺激与假刺激，生物反馈-盆底肌训练（biofeedback-pelvic floor muscle training, BF-PFMT）与单纯盆底肌训练（pelvic floor muscle training, PFMT），以及PTQ™与Durasphere®等填充剂的随机对照试验中，均得到了矛盾的研究结果。在两项独立的随机对照试验中，调幅中频电刺激联合肌电生物反馈（electromyography-biofeedback, EMG-BF）的治疗方案，疗效优于单纯肌电生物反馈或单纯低频电刺激治疗。与单纯括约肌成形术相比，生物反馈联合括约肌成形术等非手术治疗方案可显著改善患者的控便评分。与非手术干预措施相比，手术治疗的严重不良事件发生率更高。**研究结论：** 当前现有证据尚未明确大便失禁各治疗方案间存在显著差异；在存在差异的研究中，不同随机对照试验的结果亦存在矛盾。