Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States.
J Pediatr Surg. 2021 Oct;56(10):1689-1693. doi: 10.1016/j.jpedsurg.2021.04.029. Epub 2021 May 8.
Many patients with anorectal malformations (ARM) need a bowel management program (BMP) to manage lifelong problems of fecal incontinence or severe constipation. We aimed to evaluate the sustainability of the results in such a program.
A single-institution retrospective review was performed in children with ARM who attended our BMP (2015-2019). Standardized definitions and validated tools were used to assess fecal continence (Baylor Continence Scale), constipation (Cleveland Constipation Scoring System), urinary symptoms (Vancouver Symptoms Score), and the Pediatric Quality of Life (PedsQL) and health-related quality of life (HRQOL) at the start of BMP and 1-year after completion of the program.
222 patients with ARM at a median age of 6.7 (IQR, 4.9-10.1) years were identified. All (100%) soiled at intake with 149 (67.1%) patients being treated with rectal or antegrade enemas and 73 (32.9%) with oral laxatives. At 1 year 150 (70.4%) were clean, 72.7% were on enemas and 27.3% were on laxatives (p = 0.08). 109 out of 148 (73.6%) patients were clean on enemas. A further 41 out of 66 (62.1%) patients were continent on laxatives with voluntary bowel movements and clean. In the group that was clean, there was improvement in Baylor Continence Scale (25 vs. 13.0, p < 0.000000002), Vancouver (11 vs. 6, p = 0.0110) scores, and clinically relevant improvement in the total PedsQL HRQL (78-85) and the PedsQL HRQL physical function (86-92) and psychosocial domain (77-82). There was no improvement in Cleveland (10 vs. 9, p = 0.31) score.
An intensive BMP offers significant benefits in the treatment of fecal incontinence in ARM. It appears to also improve urinary incontinence and urinary voiding as well as the patient's quality of life. These changes are sustainable over at least one year.
许多肛门直肠畸形（ARM）患者需要进行肠道管理计划（BMP）以长期解决粪便失禁或严重便秘的问题。我们旨在评估该计划的可持续性。
对在我院接受 BMP（2015-2019 年）的 ARM 患儿进行单机构回顾性研究。使用标准化定义和经过验证的工具评估粪便失禁（贝勒粪便失禁量表）、便秘（克利夫兰便秘评分系统）、尿症状（温哥华症状评分）以及儿科生活质量（PedsQL）和健康相关生活质量（HRQOL）在 BMP 开始时和完成后 1 年。
共纳入 222 例 ARM 患儿，中位年龄 6.7（IQR，4.9-10.1）岁。所有患者（100%）入组时均有粪便污染，其中 149 例（67.1%）患者接受直肠或逆行灌肠治疗，73 例（32.9%）患者接受口服泻药治疗。1 年后，150 例（70.4%）患者清洁，72.7%接受灌肠治疗，27.3%接受泻药治疗（p=0.08）。148 例中的 109 例（73.6%）患者使用灌肠剂时保持清洁。66 例中的另外 41 例（62.1%）患者使用泻药时可自主排便且保持清洁。在保持清洁的患者中，Baylor 粪便失禁量表评分（25 分比 13.0 分，p<0.000000002）、温哥华（11 分比 6 分，p=0.0110）评分均有改善，PedsQL HRQL 总分（78-85）和 PedsQL HRQL 生理功能（86-92）及心理社会领域（77-82）的临床相关改善。克利夫兰评分（10 分比 9 分，p=0.31）无改善。
强化 BMP 可显著改善 ARM 患者的粪便失禁治疗效果。它似乎还可以改善尿失禁和排尿功能以及患者的生活质量。这些变化至少可持续一年。
