Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
The Ohio State University College of Medicine, Columbus, Ohio, USA.
Neurogastroenterol Motil. 2024 Sep;36(9):e14865. doi: 10.1111/nmo.14865. Epub 2024 Jul 15.
Our objective was to evaluate long-term outcomes of sacral nerve stimulation (SNS) for children with functional and organic defecation disorders.
We performed a prospective study of children <21 years of age who started SNS treatment between 2012 and 2018. We recorded demographics, medical history, and diagnostic testing. We obtained measures of symptom severity and quality of life at baseline and follow up at 1, 6, 12, 24, 36, 48, and ≥60 months. Successful response was defined as bowel movements >2 times/week and fecal incontinence (FI) <1 time/week. Families were contacted to administer the Glasgow Children's Benefit Inventory and to evaluate patient satisfaction.
We included 65 patients (59% female, median age at SNS 14 years, range 9-21) with median follow-up of 32 months. Thirty patients had functional constipation (FC), 15 had non-retentive FI (NRFI), and 16 had an anorectal malformation (ARM). The percentage with FI <1 time/week improved from 30% at baseline to 64% at 1 year (p < 0.001) and 77% at most recent follow-up (p < 0.001). Patients with FC, NRFI, and ARM had sustained improvement in FI (p = 0.02, p < 0.001, p = 0.02). Patients also reported fewer hard stools (p = 0.001). Bowel movement frequency did not improve after SNS. At most recent follow-up, 77% of patients with a functional disorder and 50% with an organic disorder had responded (p = 0.03). Nearly all families reported benefit.
SNS led to sustained improvement in FI regardless of underlying etiology, but children with functional disorders were more likely to respond than those with organic disorders.
我们的目的是评估骶神经刺激（SNS）治疗儿童功能性和器质性排便障碍的长期疗效。
我们进行了一项前瞻性研究，纳入 2012 年至 2018 年期间开始 SNS 治疗的＜21 岁儿童。记录人口统计学、病史和诊断性检查资料。在基线和治疗后 1、6、12、24、36、48 和≥60 个月时评估症状严重程度和生活质量，并记录相关数据。成功的标准定义为每周排便＞2 次和每周失禁＜1 次。通过电话联系患者家属，采用格拉斯哥儿童受益量表评估患者满意度。
我们共纳入 65 例患者（59%为女性，SNS 治疗时的中位年龄为 14 岁，范围为 9-21 岁），中位随访时间为 32 个月。30 例为功能性便秘（FC），15 例为非潴留性粪失禁（NRFI），16 例为肛门直肠畸形（ARM）。FI＜1 次/周的比例从基线时的 30%提高到 1 年时的 64%（p＜0.001）和最近随访时的 77%（p＜0.001）。FC、NRFI 和 ARM 患者的 FI 均持续改善（p＝0.02，p＜0.001，p＝0.02）。患者还报告称硬便减少（p＝0.001）。SNS 后排便频率未改善。最近随访时，功能性障碍患者中 77%和器质性障碍患者中 50%对 SNS 治疗有反应（p＝0.03）。几乎所有家庭都报告有获益。
SNS 可改善 FI，无论潜在病因如何，且持续有效，但功能性障碍患者的反应率高于器质性障碍患者。
