Ibrahim Musa, Ismail Nasiru Jinjiri, Mohammad Mohammad Aminu, Ismail Hassan, Ahmed Misbahu Haruna, Femi Owolabi Lukman, Suwaid Mohammed Abba
Children Surgery Unit, Department of Surgery, Murtala Muhammad Specialist Hospital, Kano, Nigeria.
Department of Neurosurgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
J Pediatr Surg. 2017 Apr;52(4):554-557. doi: 10.1016/j.jpedsurg.2016.08.014. Epub 2016 Sep 5.
Neural tube defects (NTDs) are among the major causes of sphincter dysfunctions. Fecal incontinence (FI) because of myelomeningocele (MMC) leads to problems with social acceptability and decreased quality of life (QOL), life satisfaction in addition to other morbidities. This is a report of experience with antegrade continence enema (ACE) in the management of FI in patients with MMC in an African set-up.
A retrospective review of 23 children and young adults with FI because of MMC managed with ACE from October 2008 to September 2015 from African Specialist Hospital. The clinical outcomes have been analyzed.
From October 2008 to September 2015, a total of thirty-two n=32 patients underwent ACE procedure after repair of MMC associated with FI. Available data of 23 (71.87%) patients were reviewed retrospectively. Mean age at which ACE was created was 6.43±3.83years, range (3.5-17.8) years, median 5years. Follow-up after ACE creation was (0.5-6.9) years, median 2.6years. There were full continence in 13 (56.52%), partial continence in 8 (34.78%) and failure in 2 (8.69%). There were 16 (69.56%) complications and 4 (17.39%) minor post ACE surgery revisions. Mean PedQOL™ score before ACE and then 5, 10, and 15months after ACE were 47.86±13.83, range (20.4-66.0) vs 88.34±7.11, range (77.9-98.6); p=0.000, 88.9±6.44 range (76.9-98.5); p=0.000, 89.01±6.50, range (76.9-98.88) p=0.000 respectively. Mean parental/caregiver satisfaction score for 15 (65.21%) patients aged 6years and below using modified visual analogue scale (VAS) 1 to 10 before ACE and after were 3.06±0.79, range (2-4), median 3 vs 8.0±1.30, range (5-10), median 8; (p=0.000) while 8 (34.78%) patients aged above 6years were able to assess their satisfactions score before and after ACE creation with mean of 1.75±0.70, range (1-3), median 2 vs 7.75±1.03, range (6-9) median 8; (p=0.000).
ACE has satisfactory outcomes in an African set-up in patients with MMC associated with FI. Multidisciplinary approach to neurogenic FI should be encouraged in such set-ups.
神经管缺陷（NTDs）是括约肌功能障碍的主要原因之一。脊髓脊膜膨出（MMC）导致的大便失禁（FI）会引发社会接受度问题、生活质量（QOL）下降、生活满意度降低以及其他疾病。这是一份关于在非洲地区对MMC患者的FI进行顺行性节制灌肠（ACE）治疗的经验报告。
对2008年10月至2015年9月在非洲专科医院接受ACE治疗的23例因MMC导致FI的儿童和青年进行回顾性研究。分析了临床结果。
2008年10月至2015年9月，共有32例与FI相关的MMC修复术后患者接受了ACE手术。对23例（71.87%）患者的可用数据进行了回顾性分析。创建ACE时的平均年龄为6.43±3.83岁，范围为（3.5 - 17.8）岁，中位数为5岁。ACE创建后的随访时间为（0.5 - 6.9）年，中位数为2.6年。完全节制的有13例（56.52%），部分节制的有8例（34.78%），失败的有2例（8.69%）。有16例（69.56%）出现并发症，4例（17.39%）在ACE手术后进行了小的修复。ACE术前、术后5个月、10个月和15个月的平均PedQOL™评分分别为47.86±13.83，范围（20.4 - 66.0）；88.34±7.11，范围（77.9 - 98.6）；p = 0.000；88.9±6.44，范围（76.9 - 98.5）；p = 0.000；89.01±6.50，范围（76.9 - 98.88），p = 0.000。15例（65.21%）6岁及以下患者使用改良视觉模拟量表（VAS）1至10评估父母/照顾者的满意度，ACE术前和术后的平均得分分别为3.06±0.79，范围（2 - 4），中位数为3；8.0±1.30，范围（5 - 10），中位数为8；（p = 0.000），而8例（34.78%）6岁以上患者能够评估ACE创建前后的满意度得分，平均得分分别为1.75±0.70，范围（1 - 3），中位数为2；7.75±1.03，范围（6 - 9），中位数为8；（p = 0.000）。
在非洲地区，ACE治疗与FI相关的MMC患者取得了令人满意的结果。在这种情况下，应鼓励采用多学科方法治疗神经源性FI。
