骶神经刺激可减少重度便秘患儿的顺行性灌肠使用。
Sacral nerve stimulation allows for decreased antegrade continence enema use in children with severe constipation.
作者信息
Lu Peter L, Asti Lindsey, Lodwick Daniel L, Nacion Kristine M, Deans Katherine J, Minneci Peter C, Teich Steven, Alpert Seth A, Yacob Desale, Di Lorenzo Carlo, Mousa Hayat M
机构信息
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
出版信息
J Pediatr Surg. 2017 Apr;52(4):558-562. doi: 10.1016/j.jpedsurg.2016.11.003. Epub 2016 Nov 10.
BACKGROUND
Sacral nerve stimulation (SNS) can be beneficial for children with constipation, but no studies have focused on children with constipation severe enough to require antegrade continence enemas (ACEs). Our objective was to evaluate the efficacy of SNS in children with constipation treated with ACE.
METHODS
Using a prospective patient registry, we identified patients <21years old who were receiving ACE prior to SNS placement. We compared ACE/laxative usage, PedsQL Gastrointestinal Symptom Scale (GSS), Fecal Incontinence Quality of Life Scale (FIQL), Fecal Incontinence Severity Index (FISI), and Vancouver Dysfunctional Elimination Syndrome Score (DES) at baseline and progressive follow-up time intervals.
RESULTS
Twenty-two patients (55% male, median 12years) were included. Median ACE frequency decreased from 7 per week at baseline to 1 per week at 12months (p<0.0001). Ten children (45%) had their cecostomy/appendicostomy closed. Laxative use, GSS, FIQL, and DES did not change. FISI improved over the first 12months with statistical significance reached only at 6months (p=0.02). Six (27%) children experienced complications after SNS that required further surgery.
CONCLUSIONS
In children with severe constipation dependent on ACE, SNS led to a steady decrease in ACE usage with nearly half of patients receiving cecostomy/appendicostomy closure within 2years.
LEVEL OF EVIDENCE
IV.
背景
骶神经刺激（SNS）对便秘儿童可能有益，但尚无研究聚焦于便秘严重到需要顺行性节制灌肠（ACE）的儿童。我们的目的是评估SNS对接受ACE治疗的便秘儿童的疗效。
方法
通过前瞻性患者登记系统，我们确定了在植入SNS之前正在接受ACE治疗的21岁以下患者。我们比较了基线时以及后续随访时间点的ACE/泻药使用情况、儿童生活质量量表（PedsQL）胃肠道症状量表（GSS）、大便失禁生活质量量表（FIQL）、大便失禁严重程度指数（FISI）和温哥华功能失调性排便综合征评分（DES）。
结果
纳入了22例患者（55%为男性，中位年龄12岁）。ACE的使用频率中位数从基线时的每周7次降至12个月时的每周1次（p<0.0001）。10名儿童（45%）的盲肠造口术/阑尾造口术被关闭。泻药使用情况、GSS、FIQL和DES没有变化。FISI在最初12个月有所改善，仅在6个月时达到统计学显著性（p=0.02）。6名（27%）儿童在SNS植入后出现并发症，需要进一步手术。
结论
对于依赖ACE治疗的严重便秘儿童，SNS使ACE的使用稳步减少，近一半患者在2年内接受了盲肠造口术/阑尾造口术关闭。
证据级别
IV级。
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