Ambartsumyan Lusine, Rodriguez Leonel
Division of Gastroenterology and Hepatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Colorectal and Pelvic Malformations Center, Division of Gastroenterology, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
J Pediatr Rehabil Med. 2018;11(4):293-301. doi: 10.3233/PRM-170533. Epub 2018 Nov 28.
Spina bifida is a birth defect that commonly causes bowel and bladder dysfunction in children with a significant negative impact on quality of life and emotional wellbeing. Fecal continence improves satisfaction and the quality of life of both children and their caretakers. Bowel management in children with spina bifida is hampered by limited controlled studies and variable practice within different institutions and subspecialists. The goals of a successful bowel management program in children with spina bifida consist of predictable bowel movements, social continence, and eventual independence. Treatment options range from conservative interventions such as diets and oral laxatives that modify stool consistency and transit, to trans-anal irrigations and antegrade continence enemas that facilitate predictable recto-sigmoid emptying and provide a greater degree of independence. In children, the treatment approach should be implemented in the context of the child's developmental age in order to allow for optimum social integration with their age-appropriate peers. We present a review of a stepwise approach to bowel management in children with spina bifida and the challenges related to the proposed treatment options.
脊柱裂是一种出生缺陷，通常会导致儿童出现肠道和膀胱功能障碍，对生活质量和心理健康产生重大负面影响。大便失禁会降低儿童及其照料者的满意度和生活质量。由于对照研究有限，且不同机构和亚专科的实践存在差异，脊柱裂患儿的肠道管理受到阻碍。成功的脊柱裂患儿肠道管理计划的目标包括可预测的排便、社交性大便失禁以及最终实现独立。治疗选择范围广泛，从保守干预措施，如调整大便质地和通过饮食及口服泻药改变排便时间，到经肛门冲洗和顺行性可控灌肠，后者有助于实现可预测的直肠乙状结肠排空，并提供更高程度的独立性。对于儿童，治疗方法应根据其发育年龄来实施，以便与年龄相仿的同龄人实现最佳的社会融合。我们对脊柱裂患儿肠道管理的逐步方法以及与所提议治疗选择相关的挑战进行综述。
