Umberto Bosio Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
Umberto Bosio Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
J Pediatr Surg. 2024 Sep;59(9):1806-1815. doi: 10.1016/j.jpedsurg.2023.12.024. Epub 2024 Jan 8.
Continence issues due to organic causes including previous colorectal surgery or neurological issues might benefit from Transanal irrigation (TAI) that proved to be highly effective but with a number of limitations including a relatively high discontinuation rates. Our study was aimed at evaluating the efficacy of an advanced protocol tailored to each patient to prevent dropout and increase satisfaction, independence, and quality of life.
This was a prospective, interventional, multicenter, nonrandomized study involving children aged 4-18 years with bowel dysfunction unresponsive to conventional treatments who required TAI. TAI was performed in accordance to the best standards of care with a total irrigation volume that was determined based on low emission X-Ray barium enemas performed at the very beginning of the study. All patients underwent training and assessments of continence, patients' perspectives and quality of life were performed at different timepoints from enrollment (T0) up to 6 months since TAI was introduced (T3).
A total of 78 patients were enrolled. Male to female ratio was 1.4:1. Mean age at enrollment was 106.1 ± 42.8 months. Discontinuation was reported by 3 patients (3.8 %). Continence, satisfaction and a number of other outcome measures increased from baseline (T0) to the last visit (T3). In particular, mean Rintala total score increased linearly from 7.8 to 14.8 during the study period (T0 to T3 timepoints). On a multivariate analysis, the only parameter that proved to be inversely associated with continence as well as with other outcome measures was the use of laxatives at enrollment and during the study.
This study has demonstrated the high efficacy of this innovative patient-tailored TAI protocol across all assessed scores. Of note, given the negative impact of laxatives, our findings suggest limiting their use in this patient population to further increase the efficacy of the procedure.
由于先前的结直肠手术或神经问题等器质性原因导致的控便问题可能受益于经肛门灌洗（TAI），该方法已被证实具有高度有效性，但存在一些局限性，包括相对较高的中断率。我们的研究旨在评估针对每位患者量身定制的先进方案的疗效，以防止患者脱落，并提高满意度、独立性和生活质量。
这是一项前瞻性、干预性、多中心、非随机研究，涉及对常规治疗无反应的 4-18 岁有肠道功能障碍且需要 TAI 的儿童。TAI 是根据最佳护理标准进行的，总灌洗量是根据研究开始时进行的低排放 X 射线钡灌肠来确定的。所有患者均接受培训和控便评估，在入组（T0）至 TAI 引入后 6 个月（T3）的不同时间点评估患者的观点和生活质量。
共纳入 78 例患者。男女比例为 1.4:1。入组时的平均年龄为 106.1±42.8 个月。有 3 例患者（3.8%）报告中断。从基线（T0）到最后一次就诊（T3），控便、满意度和其他一些结果测量均有所增加。特别是，Rintala 总评分在研究期间（T0 至 T3 时间点）从 7.8 线性增加到 14.8。在多变量分析中，唯一与控便以及其他结果测量呈负相关的参数是入组时和研究期间使用泻药。
本研究证明了这种创新的针对患者的 TAI 方案在所有评估评分中的高疗效。值得注意的是，鉴于泻药的负面影响，我们的研究结果表明，在该患者人群中限制使用泻药可进一步提高该手术的疗效。
