Brazzelli M, Griffiths P
University of Edinburgh, Bramwell Dott Building, Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU.
Cochrane Database Syst Rev. 2006 Apr 19(2):CD002240. doi: 10.1002/14651858.CD002240.pub3.
Faecal incontinence is a common and potentially distressing disorder of childhood.
To assess the effects of behavioural and/or cognitive interventions for the management of faecal incontinence in children.
We searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 February 2006).
Randomised and quasi-randomised trials of behavioural and/or cognitive interventions with or without other treatments for the management of faecal incontinence in children.
Reviewers selected studies from the literature, assessed study quality, and extracted data. Data were combined in a meta-analysis when appropriate.
Eighteen randomised trials with a total of 1168 children met the inclusion criteria. Sample sizes were generally small. All studies but one investigated children with functional faecal incontinence. Interventions varied amongst trials and few outcomes were shared by trials addressing the same comparisons. Combined results of nine trials showed higher rather than lower rates of persisting symptoms of faecal incontinence up to 12 months when biofeedback was added to conventional treatment (OR 1.11 CI 95% 0.78 to 1.58). This result was consistent with that of two trials with longer follow-up (OR 1.31 CI 95% 0.80 to 2.15). In one trial the adjunct of anorectal manometry to conventional treatment did not result in higher success rates in chronically constipated children (OR 1.40 95% CI 0.72 to 2.73 at 24 months). In one small trial the adjunct of behaviour modification to laxative therapy was associated with a significant reduction in children's soiling episodes at both the three month (OR 0.14 CI 95% 0.04 to 0.51) and the 12 month assessment (OR 0.20 CI 95% 0.06 to 0.65).
AUTHORS' CONCLUSIONS: There is no evidence that biofeedback training adds any benefit to conventional treatment in the management of functional faecal incontinence in children. There was not enough evidence on which to assess the effects of biofeedback for the management of organic faecal incontinence. There is some evidence that behavioural interventions plus laxative therapy, rather than laxative therapy alone, improves continence in children with functional faecal incontinence associated with constipation.
大便失禁是儿童期常见且可能令人苦恼的病症。
评估行为和/或认知干预对儿童大便失禁管理的效果。
我们检索了Cochrane尿失禁组专业试验注册库（检索时间为2006年2月1日）。
行为和/或认知干预的随机和半随机试验，无论是否联合其他治疗方法用于儿童大便失禁的管理。
综述作者从文献中选择研究，评估研究质量并提取数据。适当时将数据进行荟萃分析。
18项随机试验共纳入1168名儿童，符合纳入标准。样本量通常较小。除一项研究外，所有研究均针对功能性大便失禁儿童。各试验的干预措施不同，针对相同比较的试验很少有共同的结果。9项试验的综合结果显示，在传统治疗基础上加用生物反馈治疗后，长达12个月时大便失禁持续症状的发生率较高而非较低（比值比1.11，95%置信区间0.78至1.58）。该结果与两项随访时间更长的试验结果一致（比值比1.31，95%置信区间0.80至2.15）。在一项试验中，对慢性便秘儿童在传统治疗基础上加用肛门直肠测压法并未提高成功率（24个月时比值比1.40，95%置信区间0.72至2.73）。在一项小型试验中，在泻药治疗基础上加用行为矫正法与在3个月（比值比0.14，95%置信区间0.04至0.51）和12个月评估时（比值比0.20，95%置信区间0.06至0.65）儿童的弄脏发作显著减少相关。
没有证据表明生物反馈训练在儿童功能性大便失禁管理中能给传统治疗带来任何益处。没有足够证据评估生物反馈对器质性大便失禁管理的效果。有一些证据表明，行为干预加泻药治疗而非单纯泻药治疗可改善与便秘相关的功能性大便失禁儿童的控便能力。
