单独顺行失禁灌肠治疗功能性便秘和节段性结肠运动障碍(ACE-FC):一项儿科结肠直肠和骨盆学习联合会研究。

IF 1.5 3区 医学 Q2 PEDIATRICS
European Journal of Pediatric Surgery Pub Date : 2024-10-01 Epub Date: 2023-11-08 DOI:10.1055/a-2206-6508
Hira Ahmad, Caitlin Smith, Amanda Witte, Katelyn Lewis, Ron William Reeder, Jose Garza, Sarah Zobell, Kathleen Hoff, Megan Durham, Casey Calkins, Michael D Rollins, Lusine Ambartsumyan, Rebecca Maria Rentea, Desale Yacob, Carlo Di Lorenzo, Marc A Levitt, Richard J Wood
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引用次数: 0

摘要

目的:本研究的目的是确定单独顺行失禁灌肠(ACE)是否是治疗严重功能性便秘和节段性结肠运动障碍患者的有效方法。方法:对功能性便秘和节段性结肠运动障碍患者进行回顾性研究,并将ACE作为其最初的治疗手段。数据来自儿科结直肠和骨盆学习联盟(PCPLC)的六个参与站点。与ACE同时或之前进行结肠切除的患者被排除在分析之外。仅包括年龄≤21岁且ACE后随访至少一年的患者。所有患者均有结肠测压(CMAN)记录的节段性结肠运动障碍。总结了患者特征,包括术前结肠和肛门直肠测压,并使用Fisher精确检验和Wilcoxon秩和检验评估了ACE后结肠切除的相关性。结果的P值:共有来自六个机构的104名患者被纳入研究,性别分布均匀(男性n=50,48.1%),中位年龄为9.6岁(IQR 7.4,12.8)。在一年的随访中,96名患者(92%)仅用ACE成功治疗,8名患者(7%)因持续症状接受了结肠切除术。行为障碍、肠道管理类型和对肛门括约肌注射肉毒杆菌毒素的需要与随后结肠切除的需要无关。在肛门直肠测压方面,盆底协同失调的缺乏与后续结肠切除的需要显著相关;3/8,37.5%无盆腔协同失调,1/8,12.5%有盆腔协同失调(P=0.023)接受了随后的结肠切除术。结论:对于有严重功能性便秘和节段性结肠运动障碍的患者,在一年的随访中,单独顺行失禁灌肠是一种有效的治疗方式。在肛门直肠测压方面没有盆底协同失调的患者更有可能在ACE后接受结肠切除术。绝大多数此类患者可以避免结肠切除术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Antegrade Continence Enema Alone for the Management of Functional Constipation and Segmental Colonic Dysmotility (ACE-FC): A Pediatric Colorectal and Pelvic Learning Consortium Study.

Objective:  The purpose of the study was to determine if antegrade continence enema (ACE) alone is an effective treatment for patients with severe functional constipation and segmental colonic dysmotility.

Methods:  A retrospective study of patients with functional constipation and segmental colonic dysmotility who underwent ACE as their initial means of management. Data was collected from six participating sites in the Pediatric Colorectal and Pelvic Learning Consortium. Patients who had a colonic resection at the same time as an ACE or previously were excluded from analysis. Only patients who were 21 years old or younger and had at least 1-year follow-up after ACE were included. All patients had segmental colonic dysmotility documented by colonic manometry. Patient characteristics including preoperative colonic and anorectal manometry were summarized, and associations with colonic resection following ACE were evaluated using Fisher's exact test and Wilcoxon rank-sum test. p-Values of less than 0.05 were considered significant. Statistical analyses and summaries were performed using SAS version 9.4 (SAS Institute Inc., Cary, North Carolina, United States).

Results:  A total of 104 patients from 6 institutions were included in the study with an even gender distribution (males n = 50, 48.1%) and a median age of 9.6 years (interquartile range 7.4, 12.8). At 1-year follow-up, 96 patients (92%) were successfully managed with ACE alone and 8 patients (7%) underwent subsequent colonic resection for persistent symptoms. Behavioral disorder, type of bowel management, and the need for botulinum toxin administered to the anal sphincters was not associated with the need for subsequent colonic resection. On anorectal manometry, lack of pelvic floor dyssynergia was significantly associated with the need for subsequent colonic resection; 3/8, 37.5% without pelvic dyssynergia versus 1/8, 12.5% (p = 0.023) with pelvic dyssynergia underwent subsequent colonic resection.

Conclusion:  In patients with severe functional constipation and documented segmental colonic dysmotility, ACE alone is an effective treatment modality at 1-year follow-up. Patients without pelvic floor dyssynergia on anorectal manometry are more likely to receive colonic resection after ACE. The vast majority of such patients can avoid a colonic resection.

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来源期刊
CiteScore
3.90
自引率
5.60%
发文量
66
审稿时长
6-12 weeks
期刊介绍: This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.
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