Bildstein Clémence, Melchior Chloé, Gourcerol Guillaume, Boueyre Estelle, Bridoux Valérie, Vérin Eric, Leroi Anne-Marie
Clémence Bildstein, Chloé Melchior, Guillaume Gourcerol, Estelle Boueyre, Anne-Marie Leroi, INSERM U1073, Service de Physiologie Digestive, CHU Rouen, F-76000 Rouen, France.
World J Gastroenterol. 2017 Mar 21;23(11):2029-2036. doi: 10.3748/wjg.v23.i11.2029.
To investigate compliance with transanal irrigation (TAI) one year after a training session and to identify predictive factors for compliance.
The compliance of one hundred eight patients [87 women and 21 men; median age 55 years (range 18-83)] suffering from constipation or fecal incontinence (FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and training progress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of intention-to-treat.
Forty-six of the 108 (43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy (41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems (catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training (OR = 4.9, 1.3-18.9, = 0.02).
The progress of the training session was the only factor that predicted patient compliance with TAI.
调查培训课程一年后经肛门冲洗（TAI）的依从性，并确定依从性的预测因素。
回顾性评估了108例患有便秘或大便失禁（FI）的患者[87名女性和21名男性；中位年龄55岁（范围18 - 83岁）]的依从性。这些患者在单一机构接受了为期四年的TAI培训。如果他们在开始治疗后至少持续使用TAI一年，则被分类为采用者；如果停止使用，则被分类为非采用者。TAI依从性的预测因素基于治疗前评估和培训进展情况。纳入TAI治疗的整个患者队列的结果按意向性分析进行表述。
108例接受培训的患者中有46例（43%）在培训课程一年后继续使用TAI。FI患者的效果最佳，54.5%的患者持续依从TAI。抱怨慢传输型便秘或排便梗阻综合征的患者中只有三分之一继续使用TAI。总体停药率为57%。停止TAI最常见的原因是缺乏疗效（41%）。然而，36%停止TAI的患者给出的原因与治疗效果无关，如技术问题（导管排出、直肠球囊破裂、注入的水渗漏或潴留、冲洗时疼痛、肛门出血、肛裂）；23%的患者表示限制太多。在报告停止TAI的患者中，唯一的预测因素是培训进展情况（OR = 4.9，1.3 - 18.9，P = 0.02）。
培训课程的进展情况是预测患者对TAI依从性的唯一因素。
