神经调控治疗功能性排便障碍的研究进展
Research Progress of Neuromodulation Therapy for Functional Defecation Disorders
摘要: 功能性排便障碍(Functional Defecation Disorders, FDD)是一种常见的功能性肠道疾病，主要表现为排便费力、排便不尽感等症状。近年来，神经调控治疗作为一种新兴的非药物治疗方法，通过调节神经系统功能来改善FDD患者的症状，受到越来越多的关注。本文综述了多种神经调控技术(包括磁刺激、骶神经电刺激、胫神经电刺激和结肠电刺激等)的研究进展，探讨了其作用机制、临床疗效、潜在机制以及未来研究方向，旨在为临床应用提供参考。
Abstract: Functional Defecation Disorders (FDD) are a common type of functional intestinal disease, mainly characterized by symptoms such as difficulty in defecation and a feeling of incomplete defecation. In recent years, neuroregulatory therapy, as an emerging non-drug therapy, has received more and more attention to improve the symptoms of patients with FDD by regulating nervous system function. In this review, the research progress of various neuroregulatory techniques (including magnetic stimulation, sacral nerve electrical stimulation, tibial nerve electrical stimulation and colonic electrical stimulation) is reviewed, and the mechanism of action, clinical efficacy, potential mechanism and future research direction are discussed, aiming to provide a reference for clinical application.
文章引用：麻春蓉, 戴宁. 神经调控治疗功能性排便障碍的研究进展[J]. 临床医学进展, 2025, 15(8): 615-624. https://doi.org/10.12677/acm.2025.1582274

参考文献

[1] Rao, S.S.C., Bharucha, A.E., Chiarioni, G., Felt-Bersma, R., Knowles, C., Malcolm, A., et al. (2016) Anorectal Disorders. Gastroenterology, 150, 1430-1442.e4. [Google Scholar] [CrossRef] [PubMed]
[2] D. Drossman. 罗马IV: 功能性胃肠病肠-脑互动异常(第2卷, 中文翻译版) [M]. 方秀才, 等, 译. 北京: 科学出版社, 2016: 1305.
[3] Ancona, A., Petito, C., Iavarone, I., Petito, V., Galasso, L., Leonetti, A., et al. (2021) The Gut-Brain Axis in Irritable Bowel Syndrome and Inflammatory Bowel Disease. Digestive and Liver Disease, 53, 298-305. [Google Scholar] [CrossRef] [PubMed]
[4] Carabotti, M., Scirocco, A., Maselli, M.A., et al. (2015) The Gut-Brain Axis: Interactions between Enteric Microbiota, Central and Enteric Nervous Systems. Annals of Gastroenterology, 28, 203-209.
[5] 程泓, 杨从敏, 孙聪. rTMS对功能性消化不良患者血浆神经肽Y和P物质水平的影响[J]. 中外医学研究, 2018, 16(26): 51-52.
[6] Spaziani, R., Bayati, A., Redmond, K., Bajaj, H., Bienenstock, J., Collins, S.M., et al. (2008) Vagal Dysfunction in Irritable Bowel Syndrome Assessed by Rectal Distension and Baroreceptor Sensitivity. Neurogastroenterology & Motility, 20, 336-342. [Google Scholar] [CrossRef] [PubMed]
[7] Burke, M.J., Fried, P.J. and Pascual-Leone, A. (2019) Transcranial Magnetic Stimulation: Neurophysiological and Clinical Applications. In: Handbook of Clinical Neurology, Elsevier, 73-92. [Google Scholar] [CrossRef] [PubMed]
[8] Klomjai, W., Katz, R. and Lackmy-Vallée, A. (2015) Basic Principles of Transcranial Magnetic Stimulation (TMS) and Repetitive TMS (rTMS). Annals of Physical and Rehabilitation Medicine, 58, 208-213. [Google Scholar] [CrossRef] [PubMed]
[9] Morgante, F., Espay, A.J., Gunraj, C., Lang, A.E. and Chen, R. (2006) Motor Cortex Plasticity in Parkinson’s Disease and Levodopa-Induced Dyskinesias. Brain, 129, 1059-1069. [Google Scholar] [CrossRef] [PubMed]
[10] 李雪静, 喻巍, 苏晶, 等. 经颅磁刺激联合电针治疗功能性便秘患者的临床疗效观察[J]. 临床医药文献电子杂志, 2019, 6(97): 64-66.
[11] 韩鹏飞, 孙莉, 陈长浩. 重复经颅磁刺激联合帕罗西汀治疗女性抑郁症伴功能性胃肠病的疗效及安全性评价[J]. 中南医学科学杂志, 2021, 49(2): 173-177.
[12] 李光耀. 生物物理治疗在功能性肠病中的作用[D]: [硕士学位论文]. 大连: 大连医科大学, 2023.
[13] 赵坚, 江仕君, 孙艺玮, 等. 经皮脉冲磁刺激骶髓神经治疗截瘫患者便秘的效果[J]. 中华现代护理杂志, 2014, 20(17): 2085-2087.
[14] 吴本升, 孙明明, 颜帅, 等. 骶神经磁刺激联合生物反馈治疗功能性排粪障碍的疗效观察[J]. 结直肠肛门外科, 2021, 27(1): 29-34.
[15] Wang, C.P. and Tsai, P.Y. (2012) Efficacy of Spinal Magnetic Stimulation in Elderly Persons with Chronic Constipation. Journal of the Chinese Medical Association, 75, 127-131. [Google Scholar] [CrossRef] [PubMed]
[16] 刘璠, 郑鸿雁, 倪敏. 盆底磁刺激的临床应用研究进展[J]. 中外医学研究, 2023, 21(36): 175-179.
[17] 金绍兰, 贺潇月. 盆底磁刺激联合生物反馈治疗盆底失弛缓型便秘30例疗效观察[J]. 中国肛肠病杂志, 2021, 41(9): 51-53.
[18] Bae, E.H., Schrader, L.M., Machii, K., Alonso-Alonso, M., Riviello, J.J., Pascual-Leone, A., et al. (2007) Safety and Tolerability of Repetitive Transcranial Magnetic Stimulation in Patients with Epilepsy: A Review of the Literature. Epilepsy & Behavior, 10, 521-528. [Google Scholar] [CrossRef] [PubMed]
[19] Song, G., Trujillo, S., Fu, Y., Shibi, F., Chen, J. and Fass, R. (2023) Transcutaneous Electrical Stimulation for Gastrointestinal Motility Disorders. Neurogastroenterology & Motility, 35, e14618. [Google Scholar] [CrossRef] [PubMed]
[20] Yap, J.Y.Y., Keatch, C., Lambert, E., Woods, W., Stoddart, P.R. and Kameneva, T. (2020) Critical Review of Transcutaneous Vagus Nerve Stimulation: Challenges for Translation to Clinical Practice. Frontiers in Neuroscience, 14, Article 284. [Google Scholar] [CrossRef] [PubMed]
[21] Mogilevski, T., Burgell, R., Aziz, Q. and Gibson, P.R. (2019) Review Article: The Role of the Autonomic Nervous System in the Pathogenesis and Therapy of IBD. Alimentary Pharmacology & Therapeutics, 50, 720-737. [Google Scholar] [CrossRef] [PubMed]
[22] Farmer, A.D., Albusoda, A., Amarasinghe, G., Ruffle, J.K., Fitzke, H.E., Idrees, R., et al. (2020) Transcutaneous Vagus Nerve Stimulation Prevents the Development of, and Reverses, Established Oesophageal Pain Hypersensitivity. Alimentary Pharmacology & Therapeutics, 52, 988-996. [Google Scholar] [CrossRef] [PubMed]
[23] 丁雨, 姜柳琴, 俞汀, 等. 骶神经刺激治疗慢性便秘的研究进展[J]. 中华内科杂志, 2019, 58(6): 464-467.
[24] 柳凯伦, 王志民. 骶神经电刺激在治疗肛门直肠疾病中的作用[J]. 中华胃肠外科杂志, 2014(12): 1261-1263.
[25] Ortiz, H., de Miguel, M., Rinaldi, M., Oteiza, F. and Altomare, D.F. (2012) Functional Outcome of Sacral Nerve Stimulation in Patients with Severe Constipation. Diseases of the Colon & Rectum, 55, 876-880. [Google Scholar] [CrossRef] [PubMed]
[26] 李欣, 赵刚, 张立泽, 等. 骶神经刺激对功能性出口梗阻型便秘的动力学影响及疗效观察[J]. 山东医药, 2013, 53(37): 68-70.
[27] 张波, 郑建勇, 李世森, 等. 非植入性骶神经刺激对功能性便秘患者NOS、CCK表达及症状的近期影响[J]. 中国临床医学, 2022, 29(5): 837-842.
[28] 岳雨珊, 马召玺, 陆轲, 等. 经胫神经电刺激对脑卒中后便秘的康复效果[J]. 中国康复医学杂志, 2022, 37(12): 1697-1699.
[29] Madbouly, K.M., Abbas, K.S. and Emanuel, E. (2017) Bilateral Posterior Tibial Nerve Stimulation in the Treatment of Rectal Evacuation Disorder: A Preliminary Report. Diseases of the Colon & Rectum, 60, 311-317. [Google Scholar] [CrossRef] [PubMed]
[30] Hamedfar, M., Ghaderi, F., Salehi Pourmehr, H., et al. (2024) Posterior Tibial Nerve Electrical Stimulation in Chronic Constipation: A Systematic Review and Meta-Analysis. Gastroenterol Hepatol Bed Bench, 17, 6-16.
[31] Wu, G.J., Xu, F., Sun, X.M., et al. (2020) Transcutaneous Neuromodulation at ST36 (Zusanli) Is More Effective than Transcutaneous Tibial Nerve Stimulation in Treating Constipation. Journal of Clinical Gastroenterology, 54, 536-544. [Google Scholar] [CrossRef] [PubMed]
[32] 刘杰. 经皮电刺激联合自适应生物反馈治疗出口梗阻型便秘的疗效研究[D]: [硕士学位论文]. 合肥: 安徽医科大学, 2022.
[33] Moore, J.S., Gibson, P.R. and Burgell, R.E. (2018) Neuromodulation via Interferential Electrical Stimulation as a Novel Therapy in Gastrointestinal Motility Disorders. Journal of Neurogastroenterology and Motility, 24, 19-29. [Google Scholar] [CrossRef] [PubMed]
[34] Moore, J.S., Gibson, P.R. and Burgell, R.E. (2020) Randomised Clinical Trial: Transabdominal Interferential Electrical Stimulation vs Sham Stimulation in Women with Functional Constipation. Alimentary Pharmacology & Therapeutics, 51, 760-769. [Google Scholar] [CrossRef] [PubMed]
[35] Clarke, M.C.C., Chase, J.W., Gibb, S., Robertson, V.J., Catto-Smith, A., Hutson, J.M., et al. (2009) Decreased Colonic Transit Time after Transcutaneous Interferential Electrical Stimulation in Children with Slow Transit Constipation. Journal of Pediatric Surgery, 44, 408-412. [Google Scholar] [CrossRef] [PubMed]
[36] Pauwels, N., Willemse, C., Hellemans, S., Komen, N., Van den Broeck, S., Roenen, J., et al. (2021) The Role of Neuromodulation in Chronic Functional Constipation: A Systematic Review. Acta Gastro Enterologica Belgica, 84, 467-476. [Google Scholar] [CrossRef] [PubMed]
[37] Sevcencu, C. (2006) Electrical Stimulation—An Evolving Concept in the Treatment of Colonic Motor Dysfunctions. Neurogastroenterology & Motility, 18, 960-970. [Google Scholar] [CrossRef] [PubMed]
[38] Ortego-Isasa, I., Ortega-Morán, J.F., Lozano, H., Stieglitz, T., Sánchez-Margallo, F.M., Usón-Gargallo, J., et al. (2024) Colonic Electrical Stimulation for Chronic Constipation: A Perspective Review. Biomedicines, 12, Article 481. [Google Scholar] [CrossRef] [PubMed]
[39] Ziegler, A., Gonzalez, L. and Blikslager, A. (2016) Large Animal Models: The Key to Translational Discovery in Digestive Disease Research. Cellular and Molecular Gastroenterology and Hepatology, 2, 716-724. [Google Scholar] [CrossRef] [PubMed]
[40] Colasante, C., Brose, S.W., Gustafson, K. and Bourbeau, D. (2023) Minimally Invasive Electrical Rectal Stimulation Promotes Bowel Emptying in an Individual with Spinal Cord Injury. The Journal of Spinal Cord Medicine, 46, 975-979. [Google Scholar] [CrossRef] [PubMed]
[41] Korsten, M.A., Singal, A.K., Monga, A., Chaparala, G., Khan, A.M., Palmon, R., et al. (2007) Anorectal Stimulation Causes Increased Colonic Motor Activity in Subjects with Spinal Cord Injury. The Journal of Spinal Cord Medicine, 30, 31-35. [Google Scholar] [CrossRef] [PubMed]
[42] Jung, K.W., Yang, D.H., Yoon, I.J., Seo, S.Y., Koo, H.S., Lee, H.J., et al. (2013) Electrical Stimulation Therapy in Chronic Functional Constipation: Five Years’ Experience in Patients Refractory to Biofeedback Therapy and with Rectal Hyposensitivity. Journal of Neurogastroenterology and Motility, 19, 366-373. [Google Scholar] [CrossRef] [PubMed]
[43] 丁曙晴. 慢性便秘生物反馈治疗的难点和策略[J]. 临床外科杂志, 2010, 18(4): 221-222.
[44] Chang, H.S., Myung, S.J., Yang, S.K., et al. (2003) Effect of Electrical Stimulation in Constipated Patients with Impaired Rectal Sensation. International Journal of Colorectal Disease, 18, 433-438. [Google Scholar] [CrossRef] [PubMed]
[45] 陈友喜. 生物反馈联合经肛电刺激治疗排便障碍型便秘的临床疗效[D]: [硕士学位论文]. 合肥: 安徽医科大学, 2019.

为你推荐