向肛门外括约肌注射肉毒杆菌毒素的长期疗效:治疗儿童慢性功能性便秘的有效新方法。

IF 2.4 2区 医学 Q1 PEDIATRICS
Alireza S Keshtgar As, Ahmad Suliman, Hemanshoo Thakkar, Iman Selim
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引用次数: 0

摘要

背景:肉毒杆菌毒素(BT)是一种公认的治疗药物难治的慢性功能性便秘(FC)和便秘的方法。本研究旨在评估在肛门外括约肌(EAS)注射肉毒杆菌毒素治疗慢性功能性便秘的短期和长期疗效:2011年4月至2023年1月期间,我们对196名因慢性FC、便秘、排便疼痛和忍耐行为(罗马III标准)而接受药物治疗无效的儿童进行了研究。所有患者均接受了肛门直肠测压(ARM)和内窥镜引导下的BT注射(Dysport®或Botox®),每公斤体重10单位(最多200单位),注射部位为3点钟和9点钟位置的EAS肌肉和结肠转运研究。术前、术后 3-6 个月和术后 12-24 个月的随访结果均采用有效的症状严重程度(SS)评分问卷进行测量,包括:排便频率和疼痛、便意、通便情况、一般健康状况、行为、症状改善情况和粪瘤。得分总和从 0 分(最佳)到 65 分(最差)不等。我们使用 Wilcoxon 符号秩检验进行配对相关分析,数据以中位数(范围)和 p 值表示:在 12 年的研究期间,196 名患者(104 名男性)接受了肛门直肠检查和肛门外括约肌 BT 注射,中位年龄为 7(1-16)岁。短期和长期随访的中位数分别为 4 (1-27) 个月和 16 (5-60) 个月。26名患者(13%)患有自闭症,14名患者(7.1%)患有注意力缺陷多动障碍(ADHD)。肛门括约肌静息压力中位数为 55(20.5-113)毫米汞柱。术前的肛门括约肌总分从 BT 治疗前的中位数 31/65 (4-57) 下降到 BT 注射后 4 个月的中位数 15/65 (0-49),16 个月随访时的中位数 16/65 (0-56):BT 注射是治疗对常规药物治疗无效的慢性 FC 的一种有效、安全的新疗法。根据我们的经验,80% 的患儿症状得到明显改善,9% 的患儿在长期随访期间需要重复注射 BT。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-term Outcomes of Botulinum Toxin Injection Into the External Anal Sphincters: An Effective New Treatment of Chronic Functional Constipation in Children.

Background: Botulinum toxin (BT) is a well-recognised treatment of chronic functional constipation (FC) and soiling refractory to medical treatment. The aims of this study were to assess the short and long-term outcomes of BT injection into the external anal sphincter muscles (EAS) for chronic FC treatment.

Methods: We studied 196 children unresponsive to medical management of chronic FC, soiling, painful defecation and withholding behaviour (Rome III criteria) from April 2011 to January 2023. All patients underwent anorectal manometry (ARM) and endosonography-guided BT injection (Dysport® or Botox®) 10 units/kg body weight (maximum 200 units) into the EAS muscles at 3 and 9 o'clock positions and colonic transit study. Outcomes were measured using a validated symptom severity (SS) score questionnaire pre-operatively, at 3-6 months and 12-24 months follow up including: defecation frequency and pain, soiling, laxative(s), general health, behaviour, symptom improvement and faecaloma. Sum of scores ranged from 0 (best) to 65 (worst). We used Wilcoxon signed-rank test for matched-pairs related analysis and data presented as median (range) and p value < 0.05 was considered significant.

Results: 196 patients (104 male) with a median age of 7 (1-16) years underwent anorectal investigations and BT injection into the external anal sphincters during 12 year study period. The median short and long term follow-up was 4 (1-27) months and 16 (5-60) months, respectively. 26 (13 %) patients had autism and 14 (7.1 %) had attention deficit hyperactivity disorder (ADHD). Median anal sphincter resting pressure was of 55 (20.5-113) mmHg. The pre-operative total SS score improved from median 31/65 (4-57) before BT treatment to median 15/65 (0-49) at 4-month after BT injection and median 16/65 (0-56) at 16-month follow-up, p < 0.001. 80 % (104/130) of patients showed significant short-term and 79 % (71/90) showed long-term improvement of their chronic FC symptoms following BT injections. 9 % (18/196) children required second BT injection for symptom recurrence and 18.3 % (36/196) required formation of an antegrade colonic enema (ACE) stoma.

Conclusion: BT injection is an effective and safe new treatment of chronic FC unresponsive to conventional medical treatments. In our experience, 80 % of children have significant improvement of their symptoms and 9 % require repeat BT injection during a long term follow-up.

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来源期刊
CiteScore
1.10
自引率
12.50%
发文量
569
审稿时长
38 days
期刊介绍: The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.
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