小儿功能性便秘的顺行性节制灌肠：一项系统评价

Antegrade Continence Enemas for Pediatric Functional Constipation: A Systematic Review.

作者信息

Jonker Charlotte A L, van der Zande Julia M J, Benninga Marc A, de Jong Justin R, Di Lorenzo Carlo, Lu Peter L, Tabbers Merit M, de Vries Ralph, Koppen Ilan J N, Gorter Ramon R

机构信息

Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.

Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA; Amsterdam UMC, University of Amsterdam, Pediatric Gastroenterology and Nutrition, Pediatric Surgery, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.

出版信息

J Pediatr Surg. 2025 Jan;60(1):161952. doi: 10.1016/j.jpedsurg.2024.161952. Epub 2024 Sep 21.

DOI:10.1016/j.jpedsurg.2024.161952

PMID:39389879

Abstract

BACKGROUND

Despite optimal conservative and medical treatment, some children with functional constipation (FC) continue to experience symptoms. Antegrade continence enema (ACE) surgery has been suggested as the primary surgical option after less invasive pharmacological and non-pharmacological interventions have not been effective. The purpose of this systematic review was to assess the outcomes of ACE for children with FC.

METHODS

Electronic databases were searched (inception-March 2024) for studies evaluating ACE surgery performed in children with FC. The primary outcome was treatment success (as defined in the original manuscript), including at least defecation frequency and/or fecal incontinence frequency. Secondary outcomes were cessation of ACE, complications, health-related quality of life (HRQoL) and patient/parent satisfaction. Quality of evidence was evaluated based on tools from the New-Ottawa Scale and Joanna Bridge Institute.

RESULTS

Thirteen studies were included, representing 477 children with FC treated with either an appendicostomy or a cecostomy. Reported treatment success rates varied widely, ranging from 32% to 100%. ACE treatment was stopped in 15% due to treatment success and in 8% due to treatment failure, leading to more invasive surgery. Complication rates ranged from 6% to 100%, requiring surgical intervention in 0% to 34%. An improvement in HRQoL following ACE treatment was reported in all three studies that assessed HRQoL. The two studies assessing patient/parent satisfaction, reported high satisfaction rates.

CONCLUSION

Reported treatment success and complication rates following ACE surgery for children with FC vary widely. This systematic review highlights the necessity for uniform definitions and treatment guidelines for ACE surgery in children with FC.

LEVEL OF EVIDENCE

III.

摘要

背景

尽管采用了最佳的保守治疗和药物治疗，但一些功能性便秘（FC）儿童仍有症状。在侵入性较小的药物和非药物干预无效后，顺行性节制灌肠（ACE）手术被建议作为主要的手术选择。本系统评价的目的是评估ACE治疗FC儿童的效果。

方法

检索电子数据库（建库至2024年3月），查找评估FC儿童接受ACE手术的研究。主要结局是治疗成功（如原始手稿中所定义），包括至少排便频率和/或大便失禁频率。次要结局是ACE停用、并发症、健康相关生活质量（HRQoL）和患者/家长满意度。基于新渥太华量表和乔安娜·布里奇研究所的工具评估证据质量。

结果

纳入13项研究，代表477例接受阑尾造口术或盲肠造口术治疗的FC儿童。报告的治疗成功率差异很大，从32%到100%不等。15%的患者因治疗成功而停止ACE治疗，8%的患者因治疗失败而停止治疗，导致更具侵入性的手术。并发症发生率从6%到100%不等，0%至34%的患者需要手术干预。在所有三项评估HRQoL的研究中，均报告ACE治疗后HRQoL有所改善。两项评估患者/家长满意度的研究报告了高满意度。