Ausili Emanuele, Marte A, Brisighelli G, Midrio P, Mosiello G, La Pergola E, Lombardi L, Iacobelli B D, Caponcelli E, Meroni M, Leva E, Rendeli C
Spina Bifida Center, Department of Science of the Health of Women and Children, Catholic University Medical School, Rome, Italy.
Spina Bifida Center-Pediatric Department, Catholic University of Sacred Heart, Largo Gemelli 8, 00168, Rome, Italy.
Childs Nerv Syst. 2018 Dec;34(12):2471-2479. doi: 10.1007/s00381-018-3860-4. Epub 2018 Jun 12.
We assessed short- and mid-long-term clinical efficacy of transanal irrigation (TAI) and its effect on the quality of life of children with spina bifida (SB) and anorectal malformations (ARM).
Seventy-four pediatric patients (age 6-17 years) with SB and ARM with neurogenic bowel dysfunction were enrolled for a prospective and multicentric study. Patients were evaluated before the beginning of TAI (T0), after 3 months (T1) and after at least 2 years (range 24-32 months) (T2) using a questionnaire assessing bowel function, the Bristol scale, and two validated questionnaires on quality of life: the CHQ-PF50 questionnaire for the parents of patients aged 6-11 years and the SF36 questionnaires for patients aged between 12 and 18 years.
Seventy-two patients completed TAI program in T1, and 67 continued into T2. Bowel outcomes (constipation and fecal incontinence) improved in both the SB and the ARM groups in the short and mid-long term. In both groups at T1 and T2, parents and children reported an improvement in quality of life and there was a significant increase of stool form types 4 and 5 as described by the Bristol scale. Common adverse effects during the study were similar at T1 and T2 without serious complications.
We observed a sustained improvement in bowel management and quality of life in SB and ARM children during the study, more significant in the short term than in mid-long term. To maintain success rates in the mid-long term and to reduce the dropout rate, we propose patient training and careful follow-ups.
我们评估了经肛门冲洗（TAI）的短期和中长期临床疗效及其对脊柱裂（SB）和肛门直肠畸形（ARM）患儿生活质量的影响。
74例患有SB和ARM且伴有神经源性肠道功能障碍的儿科患者（年龄6 - 17岁）被纳入一项前瞻性多中心研究。在TAI开始前（T0）、3个月后（T1）以及至少2年后（范围24 - 32个月）（T2），使用一份评估肠道功能的问卷、布里斯托量表以及两份经过验证的生活质量问卷对患者进行评估：针对6 - 11岁患者家长的CHQ - PF50问卷和针对12 - 18岁患者的SF36问卷。
72例患者在T1完成了TAI项目，67例继续进入T2阶段。SB组和ARM组的肠道结局（便秘和大便失禁）在短期和中长期均有所改善。在T1和T2时，两组的家长和孩子均报告生活质量有所提高，并且按照布里斯托量表描述，4型和5型粪便的类型显著增加。研究期间的常见不良反应在T1和T2时相似，无严重并发症。
在研究期间，我们观察到SB和ARM患儿的肠道管理和生活质量持续改善，短期内比中长期更为显著。为了维持中长期的成功率并降低退出率，我们建议对患者进行培训并仔细随访。
