经肛门直肠畸形成年患者持续性大便失禁的注射填充治疗。

Injectable bulking treatment of persistent fecal incontinence in adult patients after anorectal malformations.

机构信息

Institution of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Pediatric Surgery, Akademiska Sjukhuset, Uppsala, Sweden.

Institution of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden.

出版信息

J Pediatr Surg. 2020 Mar;55(3):397-402. doi: 10.1016/j.jpedsurg.2019.06.026. Epub 2019 Jul 16.

DOI:10.1016/j.jpedsurg.2019.06.026

PMID:31493885

Abstract

BACKGROUND/PURPOSE: Injectable bulking therapy has emerged as a treatment for fecal incontinence (FI), however there are no studies including adult patients with anorectal malformations (ARM). This study aimed to evaluate non-animal stabilized hyaluronic acid with dextranomer (NASHA/Dx) for the treatment of adult ARM patients with persistent FI.

METHODS

Seven adults with ARM and incontinence to loose stool at least once weekly and without rectal or mucosal prolapse were treated with anal NASHA/Dx injection. They were evaluated preoperatively, at 6 and 18 months with a bowel function questionnaire and a 2-week bowel diary as well as FIQL and SF-36 quality of life questionnaires.

RESULTS

Before treatment, the mean number of incontinence episodes over 2 weeks was 20.7 (median 16, range 8-52). At 6 months, the corresponding figures were 5.3 (median 4, range 0-19, p = 0.018), and at 18 months the figures were 4.3 (median 2, range 1-20, p = 0.018). An improved physical function in SF-36 from 74.3 at baseline to 86.4 at 6 months was noted (p = 0.04). No serious adverse events occurred.

CONCLUSIONS

NASHA/Dx is a promising treatment option for selected adult patients with persistent FI after ARM. Longer follow up of larger patient series and studies on patients in adolescence is needed.

TYPE OF STUDY

Treatment Study.

LEVEL OF EVIDENCE

Level IV.

摘要

背景/目的：注射性填充疗法已成为治疗粪便失禁（FI）的一种方法，但目前尚无针对肛门直肠畸形（ARM）成年患者的研究。本研究旨在评估非动物稳定透明质酸与葡聚糖微球（NASHA/Dx）治疗持续性 ARM 成年 FI 患者的效果。

方法

7 名 ARM 成年患者，每周至少有一次稀便失禁且无直肠或黏膜脱垂，接受肛门 NASHA/Dx 注射治疗。他们在术前、术后 6 个月和 18 个月接受问卷调查，包括肠道功能问卷和 2 周排便日记，以及 FIQL 和 SF-36 生活质量问卷。

结果

治疗前，2 周内失禁发作的平均次数为 20.7 次（中位数为 16，范围 8-52）。6 个月时，相应的数字为 5.3 次（中位数 4，范围 0-19，p=0.018），18 个月时为 4.3 次（中位数 2，范围 1-20，p=0.018）。SF-36 中身体功能从基线时的 74.3 分提高到 6 个月时的 86.4 分（p=0.04）。未发生严重不良事件。