Bevill Mark D, Bonnett Kristine, Arlen Angela, Cooper Christopher, Baxter Cheryl, Storm Douglas W
University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA, USA.
Nationwide Children's Hospital, Department of Urology, Columbus, OH, USA.
J Pediatr Urol. 2017 Aug;13(4):365-370. doi: 10.1016/j.jpurol.2017.04.008. Epub 2017 May 8.
Patients with spina bifida and other spinal dysraphisms commonly suffer from fecal incontinence and constipation, which can be treated with antegrade continence enemas. Currently, information regarding outcomes and satisfaction in children who have Chait cecostomy tubes is lacking. The aim of our study was to evaluate the effectiveness of Chait cecostomy tubes in management of constipation in children with spinal dysraphisms.
A questionnaire was completed by patients and/or their families during office visits at the University of Iowa or Nationwide Children's Hospital during follow-up pediatric urology office visits. Two study groups completed the questionnaires: 1) Patients with neurogenic bowels who had a cecostomy tube in place (CT) and 2) patients with neurogenic bowels with no cecostomy tube (NCT). The survey used Likert scaled and nonrated questions to assess demographics, bowel continence, and satisfaction.
A total of 86 patients completed the questionnaire: 53 CT patients and 33 NCT patients. CT patients rated the effectiveness of their cecostomy tube in managing their constipation significantly higher than the NCT group rated the effectiveness of their conventional bowel management methods (p < 0.001). Within the CT group, 48% of patients had complete or near complete continence, 40% had partial fecal incontinence, while only 12% remained incontinent. Of the CT respondents, 88% were overall satisfied with the cecostomy tube (Figure) and 92% would have the cecostomy tube placed again. In addition, hygiene, independence, and social confidence were significantly improved compared with baseline. Complications associated with the Chait tube included granulation tissue that required treatment (60%) and pain with irrigation (24%).
CT patients reported significantly improved constipation management, fecal continence, and improved quality of life compared with NCT patients. Our pilot study demonstrates that the Chait cecostomy tube is a well-tolerated, effective means for treating constipation and achieving fecal continence with minimal side effects in patients with neurogenic bowels.
脊柱裂和其他脊柱发育异常的患者常患有大便失禁和便秘，可通过顺行性节制灌肠进行治疗。目前，关于接受Chait盲肠造瘘管治疗的儿童的治疗效果和满意度的信息尚缺。我们研究的目的是评估Chait盲肠造瘘管在治疗脊柱发育异常儿童便秘中的有效性。
患者和/或其家属在爱荷华大学或全国儿童医院的随访小儿泌尿外科门诊就诊期间填写问卷。两个研究组完成了问卷：1）有盲肠造瘘管（CT）的神经源性肠道患者和2）无盲肠造瘘管（NCT）的神经源性肠道患者。该调查使用李克特量表和非评分问题来评估人口统计学、大便节制和满意度。
共有86名患者完成了问卷：53名CT患者和33名NCT患者。CT组患者对其盲肠造瘘管在治疗便秘方面的有效性评分显著高于NCT组对其传统肠道管理方法有效性的评分（p<0.001）。在CT组中，48%的患者有完全或接近完全的节制，40%有部分大便失禁，而只有12%仍有失禁。在CT受访者中，88%对盲肠造瘘管总体满意（图），92%愿意再次置入盲肠造瘘管。此外，与基线相比，卫生、独立性和社交信心有显著改善。与Chait管相关的并发症包括需要治疗的肉芽组织（60%）和冲洗时的疼痛（24%）。
与NCT患者相比，CT患者报告便秘管理、大便节制显著改善且生活质量提高。我们的初步研究表明，Chait盲肠造瘘管是一种耐受性良好、有效的治疗方法，可用于治疗神经源性肠道患者的便秘并实现大便节制，且副作用最小。
