Shen Linghui,Zhang Shucheng,Bai Yuzuo,et al.Clinical features,classification and diagnosis of pelvic floor dysfunction in children[J].Journal of Clinical Pediatric Surgery,2022,21(01):78-83.[doi:10.3760/cma.j.cn.101785-202008071-015]
儿童盆底功能障碍的分型与诊治策略探讨
- Title:
- Clinical features,classification and diagnosis of pelvic floor dysfunction in children
- Keywords:
- Pelvic Floor Dysfunction; Pelvic Floor Disorders; Colonic Diseases; Functional; Biofeedback Therapy; Sacral Nerve Stimulation; Anorectal Manometry; Child
- 摘要:
- 目的 总结儿童盆底功能障碍（pelvic floor dysfunction，PFD）的临床表现与分型，探讨其诊治策略。方法 回顾性分析2015年1月至2019年12月在中国医科大学附属盛京医院小儿外科门诊和便秘门诊接受治疗的145例PFD患儿资料，均经客观检查排除器质性疾病并诊断为功能性盆底疾病。收集并统计分析患儿年龄、性别、临床症状及持续时间、手术或药物治疗经过以及盆底表面肌电评估、肛门直肠测压、尿流动力学等检查结果。结果 145例中，临床表现为单纯便秘35例（24.1%），污便或便失禁18例（12.4%）；单纯排尿障碍41例（28.3%），包括尿急6例、尿频11例、日间尿失禁6例、夜遗尿11例、日间夜间均出现尿失禁3例、排尿困难5例；便秘合并尿失禁46例，合并排尿困难5例，伴有下腹部不适4例。根据盆底表面肌电评估、肛门直肠测压及尿动力检查结果，将145例患儿分为五型：Ⅰ型为高张力型（24例），Ⅱ型为低张力型（23例），Ⅲ型为协同失调型（29例），Ⅳ型为排便动力异常型（32例），Ⅴ型为感觉异常型（37例）。根据分型进行针对性盆底生物反馈训练和骶神经电刺激治疗，其中Ⅰ型采取降低肌肉张力训练，有效16例（16/24，66.7%）；Ⅱ型采取增强肌肉张力训练，有效21例（21/23，91.3%）；Ⅲ型采取改善协调性训练，有效16例（16/29，55.2%）；Ⅳ型未进行生物反馈治疗；Ⅴ型采用改善直肠黏膜敏感性的训练，有效28例（28/37，75.7%）；Ⅴ型治疗有效率差异有统计学意义（χ2=8.845，P=0.031）。Ⅰ型、Ⅲ型和Ⅴ型患儿随访1年效果良好，仅3例复发，复发率为5%。Ⅱ型在治疗结束后3个月多数患儿效果达到最佳，治疗结束后3~6个月症状开始复现，治疗结束后1年多数患儿症状复发。结论 儿童盆底功能障碍可根据临床症状和客观检查分为5种类型，联合应用盆底生物反馈训练和骶神经电刺激是有效的手段，根据临床分型选取个体化治疗方案是治疗的关键。
- Abstract:
- Objective To explore the clinical features, diagnosis and managements of pelvic floor dysfunction (PFD) in children. Methods From January 2015 to December 2019, retrospective review was conducted for clinical data of 145 BFD children.Age, gender, clinical symptoms, disease course, surgical history, medication details, results of clinical examinations (pelvic floor surface electromyography, anorectal manometry & urodynamics) and treatment protocols were recorded. Results There were simple constipation (n=35, 24.1%) and dirty stool incontinence (n=18, 12.4%).Among simple urination disorder (n=41, 28.3%), there were urinary urgency (n=6), frequent urination (n=11), daytime urinary incontinence (n=6), nocturnal enuresis (n=11), daytime & nocturnal incontinence (n=3) and dysuria (n=5); 46 cases of constipation plus urinary incontinence (n=46), constipation plus dysuria (n=5) and discomfort in lower abdomen (n=4).Based upon pelvic floor surface electromyography, anorectal manometry and urodynamics, they were divided into five types of Ⅰ (high-tension, n=24), Ⅱ (low-tension, n=23), Ⅲ (synergy, n=29), Ⅳ (abnormal defecation motility, n=32) and Ⅴ (paraesthesia, n=37).Targeted pelvic floor biofeedback training and sacral nerve electrical stimulation were performed accordingly.Type Ⅰ exercise was intended for reducing muscle tension and symptom score showed effectiveness (n=16, 66.7%); type Ⅱ for strengthening muscle tension with effectiveness (n=21, 91.3%); type Ⅲ for improving coordination with effectiveness (n=16, 55.2%); type Ⅳ receiving no biofeedback treatment; type Ⅴ for improving rectal mucosal sensitivity with effectiveness (n=28, 75.7%); The difference in effective rate was statistically significant among different groups (χ2=8.845, P=0.031).Children of types Ⅰ, Ⅲ & Ⅴ were followed up for 1 year with excellent outcomes.Three cases relapsed with a recurrence rate of 5%.In type Ⅱ, peak effect occurred mostly at Month 3 post-treatment; symptoms gradually recurred at Months 3-6 post-treatment and some cases recurred at Month 6 post-treatment and most symptoms recurred at Year 1 post-treatment.Except for repeated symptoms, none of them reported any other adverse reaction. Conclusion Pediatric PFD may be divided into five types based upon clinical symptoms and objective examinations.Combined application of pelvic floor biofeedback training and sacral nerve electrical stimulation is an effective treatment.Individualized treatment is based upon clinical classification.
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备注/Memo
收稿日期:2020-12-04。
通讯作者:张树成,Email:zhangshucheng76@126.com