与脊柱裂相关的肠道功能障碍：化繁为简。

Bowel Dysfunction Related to Spina Bifida: Keep It Simple.

作者信息

Brochard Charlène, Peyronnet Benoît, Dariel Anne, Ménard Hélène, Manunta Andréa, Ropert Alain, Neunlist Michel, Bouguen Guillaume, Siproudhis Laurent

机构信息

1 Service des Maladies de l'Appareil Digestif, Centre Hospitalier Universitaire Pontchaillou, Université de Rennes 1, Rennes, France 2 Service d'Explorations Fonctionnelles Digestives, Centre Hospitalier Universitaire Pontchaillou, Université de Rennes 1, Rennes, France 3 Institut National de la Santé et de la Recherche Médicale U1235, Université de Nantes, Nantes, France 4 Centre d'Investigation Clinique 1414, Inflammation and Physiology, Université de Rennes 1, Rennes, France 5 Service d'Urologie, Centre Hospitalier Universitaire Pontchaillou, Rennes, France 6 Centre Référence National Maladies Rares Spina Bifida, Centre Hospitalier Universitaire Pontchaillou, Rennes, France 7 Institut National de la Santé et de la Recherche Médicale U991, Université de Rennes, Rennes, France.

出版信息

Dis Colon Rectum. 2017 Nov;60(11):1209-1214. doi: 10.1097/DCR.0000000000000892.

DOI:10.1097/DCR.0000000000000892

PMID:28991086

Abstract

BACKGROUND

Although care of urological disorders in spina bifida is well established, there is yet no agreement on a standardized approach to bowel dysfunction in this population.

OBJECTIVE

The purpose of this study was to assess bowel dysfunction using validated instruments and the risk factors in adults with spina bifida.

DESIGN

A multidisciplinary team prospectively collected patient data, focusing on anorectal and urological symptoms.

SETTINGS

The study was conducted with data from a French referral center for spina bifida.

PATIENTS

A total of 228 adults with spina bifida (sex ratio men:women, 92 (40%):136 (60%)) with a median age of 34.7 years (range, 26.8-44.7 y) were assessed.

MAIN OUTCOMES MEASURES

Factors associated with severe fecal incontinence (Cleveland Clinic Incontinence Score ≥9) and severe bowel dysfunction (Neurogenic Bowel Dysfunction score ≥14) were assessed in a multivariate analysis model.

RESULTS

The prevalence rates of severe fecal incontinence and severe bowel dysfunction were 60% (130/217) and 42% (71/168). Bowel dysfunction was the second most common major concern of patients after lower urinary tract dysfunction. Male sex, obesity, urinary incontinence, and a Knowles-Eccersley-Scott symptom constipation score ≥10 were independently associated with severe fecal incontinence. Patients with soft stools had significantly less severe bowel dysfunction. Neither neurologic level nor other neurologic features of spina bifida were associated with severe fecal incontinence or severe bowel dysfunction.

LIMITATIONS

The recruitment of patients with spina bifida through a national referral center might have resulted in selection bias, and some data were missing especially regarding BMI and Neurogenic Bowel Dysfunction score (21% and 26% of missing data).

CONCLUSIONS

The prevalence rates of severe fecal incontinence and severe bowel dysfunction in adults with spina bifida were high and were adequately perceived by the patients. The present study emphasized the association of bowel dysfunction and fecal incontinence with obesity, urologic disorders, and stool consistency rather than neurologic features. See Video Abstract at http://links.lww.com/DCR/A394.

摘要

背景

尽管脊柱裂患者泌尿系统疾病的护理方法已确立，但对于该人群肠道功能障碍的标准化处理方法尚无共识。

目的

本研究旨在使用经过验证的工具评估脊柱裂成年患者的肠道功能障碍及其危险因素。

设计

一个多学科团队前瞻性地收集患者数据，重点关注肛门直肠和泌尿系统症状。

地点

本研究使用来自法国一家脊柱裂转诊中心的数据进行。

患者

共评估了228例脊柱裂成年患者（男女比例为92例（40%）：136例（60%）），中位年龄为34.7岁（范围26.8 - 44.7岁）。

主要结局指标

在多变量分析模型中评估与严重大便失禁（克利夫兰诊所失禁评分≥9）和严重肠道功能障碍（神经源性肠道功能障碍评分≥14）相关的因素。

结果

严重大便失禁和严重肠道功能障碍的患病率分别为60%（130/217）和42%（71/168）。肠道功能障碍是患者仅次于下尿路功能障碍的第二大主要担忧问题。男性、肥胖、尿失禁以及诺尔斯 - 埃克斯利 - 斯科特症状便秘评分≥10与严重大便失禁独立相关。大便质地软的患者严重肠道功能障碍的程度明显较轻。脊柱裂的神经平面及其他神经学特征均与严重大便失禁或严重肠道功能障碍无关。