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.

<b>研究目的：</b> 本研究旨在对报道成人大便失禁（faecal incontinence, FI）治疗方案对比的随机对照试验（randomised controlled trials, RCTs）的相关文献进行综述。<b>研究方法：</b> 对MEDLINE、Embase、科学引文索引扩展版（Science Citation Index Expanded）及考克兰（Cochrane）数据库开展文献检索，以筛选报道FI治疗方案的RCTs。<b>研究结果：</b> 本综述共纳入60项RCTs，涉及4838例患者，平均年龄范围为36.8至88岁。其中32项试验未在所对比的治疗方案间发现显著差异。在对比经皮胫后神经刺激与假刺激、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）与盆底肌训练（pelvic floor muscle training, PFMT），以及PTQ^TM与Durasphere^®等注射填充剂的RCTs中，研究结果存在矛盾。两项独立RCTs显示，调幅中频电刺激联合肌电生物反馈（electromyography-biofeedback, EMG-BF）的治疗方案，疗效优于单独使用EMG-BF或低频电刺激。与单独括约肌成形术相比，生物反馈等非手术治疗方案联合括约肌成形术可显著改善患者的控便评分。手术治疗方案的严重不良事件发生率显著高于非手术干预措施。<b>研究结论：</b> 当前现有证据尚未明确FI各治疗方案间存在显著差异；即便存在差异的研究报道，不同RCTs的结果也存在矛盾。