Sulkowski Jason P, Nacion Kristine M, Deans Katherine J, Minneci Peter C, Levitt Marc A, Mousa Hayat M, Alpert Seth A, Teich Steven
Center for Surgical Outcomes Research, The Research Institute Nationwide Children's Hospital, Columbus, OH; Center for Colorectal and Pelvic Reconstruction, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, Columbus, Columbus, OH.
Center for Surgical Outcomes Research, The Research Institute Nationwide Children's Hospital, Columbus, OH.
J Pediatr Surg. 2015 Oct;50(10):1644-7. doi: 10.1016/j.jpedsurg.2015.03.043. Epub 2015 Mar 26.
This study describes our series of children with bowel and bladder dysfunction (BDD) treated with sacral nerve stimulation in order to begin to identify characteristics associated with better outcomes and guide future therapies.
Between May 2012 and February 2014, 29 patients were evaluated before and after sacral nerve stimulator (SNS) placement. A prospective data registry was developed that contains clinical information and patient-reported measures: Fecal Incontinence Qualify of Life Scale, Fecal Incontinence Severity Scale, PedsQL Gastrointestinal Symptom Scale, and Vancouver DES Symptom Scale.
The median age of patients was 12.1 (interquartile range: 9.4, 14.3) years and the median follow-up period was 17.7 (12.9, 36.4) weeks. 93% had GI complaints and 65.5% had urinary symptoms while 7% had urologic symptoms only. The most common etiologies of BBD were idiopathic (66%) and imperforate anus (27%). Five patients required reoperation due to a complication with battery placement. Six of 11 patients (55%) with a pre-SNS cecostomy tube no longer require an antegrade bowel regimen as they now have voluntary bowel movements. Ten of eleven patients (91%) no longer require anticholinergic medications for bladder overactivity after receiving SNS. Significant improvements have been demonstrated in all four patient-reported instruments for the overall cohort.
Early results have demonstrated improvements in both GI and urinary function after SNS placement in pediatric patients with bowel and bladder dysfunction.
本研究描述了我们对一系列患有肠道和膀胱功能障碍（BDD）的儿童进行骶神经刺激治疗的情况，以便开始确定与更好治疗效果相关的特征并指导未来的治疗。
在2012年5月至2014年2月期间，对29例患者在植入骶神经刺激器（SNS）前后进行了评估。建立了一个前瞻性数据登记库，其中包含临床信息和患者报告的测量指标：大便失禁生活质量量表、大便失禁严重程度量表、儿童生活质量量表胃肠道症状量表和温哥华排尿症状量表。
患者的中位年龄为12.1岁（四分位间距：9.4，14.3），中位随访期为17.7周（12.9，36.4）。93%的患者有胃肠道症状，65.5%有泌尿系统症状而7%仅有泌尿系统症状。BDD最常见的病因是特发性（66%）和肛门闭锁（27%）。5例患者因电池植入并发症需要再次手术。11例术前有盲肠造瘘管的患者中有6例（55%）不再需要顺行肠道治疗方案，因为他们现在有自主排便。11例患者中有10例（91%）在接受SNS后不再需要使用抗胆碱能药物治疗膀胱过度活动症。在所有四项患者报告的测量指标中，整个队列均有显著改善。
早期结果表明，对患有肠道和膀胱功能障碍的儿科患者植入SNS后，胃肠道和泌尿系统功能均有改善。
