Christensen Peter, Krogh Klaus
Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark.
Scand J Gastroenterol. 2010 May;45(5):517-27. doi: 10.3109/00365520903583855.
Transanal irrigation for treatment of disordered defecation has been widely used among caregivers. Unique in its simplicity, reversible and minimally invasive, transanal irrigation has begun to find its place in the treatment hierarchy. Scheduled transanal irrigation aims to ensure emptying of the left colon and rectum. This prevents faecal leakage between washouts, providing a state of pseudocontinence, and re-establishes control over the time and place of defecation. Furthermore, regular evacuation of the rectosigmoid prevents constipation. The studies presented in this review represent the continuum of increasing evidence and knowledge of transanal irrigation for disordered defecation: from proof in principle through better knowledge of the physiology, towards establishing the indications and ensuring the safety of the treatment. Evidence of the superiority of transanal irrigation in spinal cord injury patients with neurogenic bowel dysfunction is provided, also from a health-economic perspective. Finally, a proposal is presented for an algorithm for the introduction of transanal irrigation for disordered defecation before irreversible surgery is considered.
经肛门灌洗治疗排便障碍已在护理人员中广泛应用。经肛门灌洗操作简单、可逆且微创，已开始在治疗体系中占据一席之地。计划性经肛门灌洗旨在确保左半结肠和直肠排空。这可防止两次灌洗之间的粪便泄漏，营造一种假性控便状态，并重新建立对排便时间和地点的控制。此外，定期排空直肠乙状结肠可预防便秘。本综述中呈现的研究代表了关于经肛门灌洗治疗排便障碍的证据和知识不断增加的过程：从原理验证到对生理学的深入了解，再到确定适应证并确保治疗安全性。还从卫生经济学角度提供了经肛门灌洗在脊髓损伤所致神经源性肠功能障碍患者中更具优势的证据。最后，提出了一项在考虑不可逆手术前引入经肛门灌洗治疗排便障碍的算法建议。
