Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China.
Am J Gastroenterol. 2023 Mar 1;118(3):553-560. doi: 10.14309/ajg.0000000000002188. Epub 2023 Jan 13.
The management of childhood constipation is challenging. Pelvic floor dysfunction (PFD) is one of the most common causes of childhood constipation. Percutaneous tibial nerve stimulation (PTNS) with pelvic floor exercises (PFE) has achieved a satisfactory outcome in the elderly individuals and women with PFD. The efficacy of PTNS with PFE in childhood constipation has not been established.
A randomized, double-blind, controlled trial with 84 children who met the inclusion criteria was conducted. All participants were randomly assigned to PTNS with PFE or sham PTNS with PFE groups and received their individual intervention for 4 weeks with a 12-week follow-up evaluation. The spontaneous bowel movements (SBM) ≥3 per week were the main outcomes, and the risk ratio (RR) with 95% confidence interval (CI) were calculated. High-resolution anorectal manometry and surface electromyography were used for the assessment of pelvic floor function, and the adverse effects were assessed based on symptoms.
At the end of the follow-up period, 26 patients (61.9%) in the PTNS with PFE group and 15 patients (35.7%) in the sham group had ≥3 SBM per week compared with baseline (net difference 26.2%, 95% CI 5.6%-46.8%; RR 2.750, 95% CI 1.384-5.466; P < 0.05). PFD remission occurred in 49 children, 33 (78.6%) in the PTNS with PFE group and 16 (38.1%) in the sham group (RR 2.063, 95% CI 1.360-3.128, P < 0.05). No adverse effects occurred.
PTNS with PFE is a safe and effective method in the treatment of childhood constipation, particularly in children with PFD or dyssynergic defecation.
儿童便秘的治疗颇具挑战。盆底功能障碍（PFD）是儿童便秘的最常见原因之一。经皮胫神经刺激（PTNS）联合盆底锻炼（PFE）在老年患者和 PFD 女性中取得了满意的效果。PTNS 联合 PFE 在儿童便秘中的疗效尚未得到证实。
我们开展了一项随机、双盲、对照临床试验，共纳入 84 名符合纳入标准的患儿。所有参与者均随机分配至 PTNS 联合 PFE 组或假 PTNS 联合 PFE 组，并接受各自的干预 4 周，随访 12 周。主要结局为每周自发性排便（SBM）≥3 次，计算风险比（RR）及其 95%置信区间（CI）。采用高分辨率肛门直肠测压和表面肌电图评估盆底功能，根据症状评估不良反应。
随访期末，PTNS 联合 PFE 组 26 例（61.9%）患儿和假 PTNS 联合 PFE 组 15 例（35.7%）患儿每周 SBM≥3 次，与基线相比差异有统计学意义（净差值 26.2%，95%CI 5.6%-46.8%；RR 2.750，95%CI 1.384-5.466；P＜0.05）。49 例患儿 PFD 缓解，PTNS 联合 PFE 组 33 例（78.6%）和假 PTNS 联合 PFE 组 16 例（38.1%）（RR 2.063，95%CI 1.360-3.128，P＜0.05）。未发生不良反应。
PTNS 联合 PFE 是治疗儿童便秘的一种安全有效的方法，尤其适用于 PFD 或协同性排便障碍的儿童。
