Pacilli Maurizio, Pallot David, Andrews Afiya, Downer Angela, Dale Louiza, Willetts Ian
Department of Paediatric Surgery and Urology, Oxford University Hospital, Oxford, UK.
Department of Paediatric Surgery and Urology, Oxford University Hospital, Oxford, UK.
J Pediatr Surg. 2014 Feb;49(2):269-72; discussion 272. doi: 10.1016/j.jpedsurg.2013.11.036. Epub 2013 Nov 18.
Transanal colonic irrigation has been shown to be effective in bowel management program in adults. However, there exist limited data in children. We appraised the effectiveness of this technique in a series of children with incontinence or constipation and overflow soiling.
Following ethical approval, a review of children with incontinence or constipation on a bowel management program with Peristeen® transanal colonic irrigation treated between 2007 and 2012 was performed. Irrigations were performed with a volume of 10-20 ml/kg of water with schedules depending on patient response. Data are reported as median (range).
Twenty-three patients were reviewed. Median age at commencement of irrigations was 7 (2-15) years. Median follow-up is 2 (0.7-3.4) years. Diagnoses include the following: spina bifida (n=11), anorectal anomaly (n=6), Hirschsprung's (n=1), and other complex anomalies (n=5). Sixteen (70%) patients had associated anomalies. Twelve (52%) had constipation and overflow soiling, and 11 (48%) had fecal incontinence. Twenty (87%) had associated urinary wetting. Sixteen (70%) children used alternate-day irrigations, 4 (17%) daily irrigations, and 3 (13%) every third-day irrigations. Nine (39%) patients were taking oral laxatives. Sixteen (70%) reported to be clean and 3 (13%) reported a significant improvement, although were having occasional soiling. Four patients (17%) did not tolerate the irrigations and underwent subsequent colostomy formation for intractable soiling.
In our experience, Peristeen® transanal colonic irrigation is an effective method of managing patients with focal soiling in childhood. Majority (83%) of children achieve social fecal continence or a significant improvement with occasional soiling. This was accompanied by high parental satisfaction. Peristeen® transanal colonic irrigation is a valid alternative to invasive surgical procedures and should be considered the first line of treatment for bowel management in children with soiling where simple pharmacological maneuvers failed to be effective.
经肛门结肠灌洗已被证明在成人肠道管理计划中有效。然而，关于儿童的数据有限。我们评估了该技术在一系列患有大便失禁或便秘及充溢性污粪的儿童中的有效性。
经伦理批准，对2007年至2012年期间在肠道管理计划中接受Peristeen®经肛门结肠灌洗治疗的大便失禁或便秘儿童进行了回顾性研究。灌洗使用的水量为10 - 20毫升/千克，灌洗频率根据患者反应而定。数据以中位数（范围）报告。
对23例患者进行了评估。开始灌洗时的中位年龄为7（2 - 15）岁。中位随访时间为2（0.7 - 3.4）年。诊断包括以下几种：脊柱裂（n = 11）、肛门直肠畸形（n = 6）、先天性巨结肠（n = 1）和其他复杂畸形（n = 5）。16例（70%）患者伴有其他异常。12例（52%）有便秘及充溢性污粪，11例（48%）有大便失禁。20例（87%）伴有尿失禁。16例（70%）儿童隔天进行灌洗，4例（17%）每天进行灌洗，3例（13%）每三天进行一次灌洗。9例（39%）患者正在服用口服泻药。16例（70%）报告大便清洁，3例（13%）报告有显著改善，尽管仍偶尔有污粪。4例（17%）患者无法耐受灌洗，随后因顽固性污粪接受了结肠造口术。
根据我们的经验，Peristeen®经肛门结肠灌洗是治疗儿童局部污粪的有效方法。大多数（83%）儿童实现了社会意义上的大便自控或虽偶尔有污粪但有显著改善。这也伴随着家长的高度满意度。Peristeen®经肛门结肠灌洗是侵入性外科手术的有效替代方法，对于简单药物治疗无效的污粪儿童，应被视为肠道管理的一线治疗方法。
