Giménez Aleixandre C, Ruiz Pruneda R, Aranda García M J, Sánchez Morote J M, Fernández Ibieta M, Villamil V, Sánchez Sánchez A, Montoya Rangel C A, Hernández Bermejo J P
Servicio de Cirugía Pediátrica. Hospital Clínico Universitario Virgen de la Arrixaca. Murcia.
Cir Pediatr. 2019 Apr 22;32(2):81-85.
To present our results with transanal irrigation (TAI) for management of fecal incontinence and fecal constipation without response to other treatments.
Retrospective study of patients with fecal constipation and/or fecal incontinence treated with TAI between 2013 and 2017. A Rintala questionnaire(1) was carried out comparing pre and post-treatment results. This study was approved by the ethical committee.
Twenty-five patients were included with a median age of 13 years old (range 6-44 years). Nineteen patients had spinal pathology (76%), four colorectal surgery (16%) and two functional constipation (8%). They presented fecal incontinence in 20% of cases, 12% of fecal constipation and 68% both conditions. After a mean follow-up of 1.5 years (1 month-4 years), 52% of the patients abandoned the treatment. The mean Rintala score was 6.8±4 before treatment, and after, resulted to 11.42±2.75 (p=0.001). The main complications throughout the treatment were pain (68%) and balloon leaks (28%). The patients declared as cause of treatment cessation: reduced mobility (15%), fear or misinformation (32%) and pain (76%). All patients with reduced mobility (n=3) left treatment, versus 45% (n=12) of the patients that had full mobility (p=0.17, OR 8.3 [IC95% 0.3-38]). Complementary treatments such as laxatives, enemas or digital extraction were abandoned in 55% of the patients.
Using TAI seems to improve quality of life in patients with fecal constipation and fecal incontinence refractory compared to other treatments. Our abandonment rate was higher than expected, so we believe it is necessary to create a support group to improve follow-ups.
介绍我们采用经肛门冲洗（TAI）治疗粪便失禁和便秘且其他治疗方法无效的患者的结果。
对2013年至2017年间接受TAI治疗的便秘和/或粪便失禁患者进行回顾性研究。采用林塔拉问卷（1）比较治疗前后的结果。本研究经伦理委员会批准。
纳入25例患者，中位年龄13岁（范围6 - 44岁）。19例患者有脊柱病变（76%），4例有结直肠手术史（16%），2例为功能性便秘（8%）。20%的患者有粪便失禁，12%的患者有便秘，68%的患者两者兼具。平均随访1.5年（1个月 - 4年）后，52%的患者放弃治疗。治疗前林塔拉平均评分为6.8±4，治疗后为11.42±2.75（p = 0.001）。治疗期间的主要并发症为疼痛（68%）和球囊泄漏（28%）。患者宣称停止治疗的原因：活动能力下降（15%）、恐惧或信息错误（32%）以及疼痛（76%）。所有活动能力下降的患者（n = 3）均停止治疗，而活动能力正常的患者中有45%（n = 12）停止治疗（p = 0.17，OR 8.3 [IC95% 0.3 - 38]）。55%的患者放弃了泻药、灌肠或手指抠便等辅助治疗。
与其他治疗方法相比，使用TAI似乎可改善难治性便秘和粪便失禁患者的生活质量。我们的放弃率高于预期，因此我们认为有必要设立一个支持小组以改善随访情况。
