Abstract：
Dyssynergic defecation (DD) is a common cause of chronic constipation. Owing to the lack of a comprehensive synthesis of available data on the effectiveness of botulinum neurotoxin (BoNT) for treating DD, we performed a systematic review and meta-analysis. We searched the PubMed, Embase, and Cochrane databases from inception to May 9, 2023. The outcomes comprise short-term and long-term symptom improvement, various anorectal function measurements, complications of fecal incontinence, and symptom improvement after repeated BoNT injections. A meta-analysis comparing BoNT injection with either surgery or biofeedback (BFB) therapy in treating DD was also conducted. Subgroup analysis and meta-regression were performed to identify possible moderator effects. We included five randomized controlled trials, seven prospective studies, and two retrospective observational studies. Short-term potential improvement in symptoms (event rate [ER], 66.4%; 95% CI, 0.513 to 0.783) was identified, but in the long-term (>12 months), this effect was decreased (ER, 38.2%; 95% CI, 0.267 to 0.511). Short-term improvements in objective anorectal physiologic parameters were also observed. Repeated BoNT injection was effective for patients with symptom recurrence. Subgroup analysis revealed enhanced long-term symptom improvement with high-dose BoNT, but this treatment also increased the risk of complications and recurrence compared with low doses. The effectiveness, complications, and recurrence of symptoms associated with BoNT injection and surgery did not differ significantly. BoNT injection significantly provided short-term symptom improvement but also heightened the risk of incontinence compared with BFB therapy. Our systematic review and meta-analysis indicated that BoNT could be beneficial for short-term symptom improvement in patients with DD, but this effect tended to decline 12 months after injection. Standardized BoNT intervention protocols remain warranted. Among the several treatments for DD, we concluded that BoNT injection is not inferior to other options considering its effectiveness in relieving symptoms, the associated complication development, and the risk of symptom recurrence.
摘要：
协同排便不良（DD）是慢性便秘的常见原因。由于缺乏关于肉毒杆菌神经毒素（BoNT）治疗DD的有效性的现有数据的综合，我们进行了系统评价和荟萃分析.我们搜查了PubMed,Embase,和Cochrane数据库从成立到2023年5月9日。结果包括短期和长期症状改善，各种肛门直肠功能测量，大便失禁的并发症，反复注射BoNT后症状改善。还进行了比较BoNT注射与手术或生物反馈（BFB）疗法治疗DD的荟萃分析。进行亚组分析和荟萃回归以确定可能的调节作用。我们纳入了五项随机对照试验，七项前瞻性研究，和两项回顾性观察研究。症状的短期潜在改善（事件发生率[ER]，66.4%；95%CI，0.513至0.783)。但从长期来看(>12个月)，这种影响降低了(ER，38.2%；95%CI，0.267至0.511）。还观察到客观肛门直肠生理参数的短期改善。反复注射BoNT对症状复发的患者有效。亚组分析显示，高剂量BoNT可增强长期症状改善，但与低剂量相比，这种治疗也增加了并发症和复发的风险。的有效性，并发症,与BoNT注射和手术相关的症状复发没有显着差异。与BFB治疗相比，BoNT注射显着改善了短期症状，但也增加了失禁的风险。我们的系统评价和荟萃分析表明，BoNT可能有利于DD患者的短期症状改善。但这种效果在注射后12个月趋于下降。标准化的BoNT干预方案仍然是必要的。在DD的几种治疗方法中，我们得出的结论是，考虑到BoNT注射液在缓解症状方面的有效性，它并不逊色于其他选择，相关的并发症发展，和症状复发的风险。
