Yue Ming,Yang Heying,Zhang Ning,et al.Influncing factors of therapeutic efficacy of biofeedback for fecal incontinence after pull-through in Hirschsprung’s disease[J].Journal of Clinical Pediatric Surgery,2024,(05):413-420.[doi:10.3760/cma.j.cn101785-202401056-003]
先天性巨结肠手术后大便失禁生物反馈治疗效果的影响因素分析
- Title:
- Influncing factors of therapeutic efficacy of biofeedback for fecal incontinence after pull-through in Hirschsprung’s disease
- Keywords:
- Biofeedback Treatment; Hirschsprung Disease; Risk Factors; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨先天性巨结肠患儿手术后大便失禁生物反馈治疗(biofeedback treatment,BFT)效果的影响因素。 方法 回顾性分析2016年6月至2023年6月在郑州大学第一附属医院完成BFT的72例先天性巨结肠手术后大便失禁患儿的临床资料,将其按治疗后每周大便失禁发作频次较治疗前减少程度分为“优、中、差”3个等级。运用单因素分析初步筛选BFT疗效的相关因素,通过有序多分类Logistic回归建立累积logit模型对影响因素进行多因素分析。 结果 单因素分析结果显示,巨结肠分型、家庭辅助锻炼、疗程间隔、治疗前vaizey评分、直肠感觉容量阈值、直肠静息压、肛管静息压、肛管最大收缩压、肛管最长收缩时间、肛门收缩协调性对BFT疗效有影响(P＜0.05)。将上述因素纳入有序多分类Logistic回归,建立累积logit模型,结果显示:疗程间隔(OR＝9.271,95%CI:1.914~54.850)、直肠感觉容量阈值(OR＝8.795,95%CI:1.247~73.225)、直肠静息压(OR＝8.795,95%CI:1.247~73.225)、肛管静息压(OR＝0.142,95%CI:0.021~0.830)、肛管最长收缩时间(OR＝0.147,95%CI:0.020~0.980)是BFT疗效的影响因素,受试者操作特征曲线显示该模型具有较好的区分度(曲线下面积为0.862,95%CI:0.771~0.953,P＜0.001)。 结论 肛门直肠测压结果是先天性巨结肠手术后大便失禁患儿BFT疗效的独立影响因素。BFT疗程间隔1周可使患儿获得更好的疗效。
- Abstract:
- Objective To explore the influncing factors for biofeedback therapeutic efficacy of fecal incontinence after pull-through in Hirschsprung’s disease (HD).Methods From June 2016 to June 2023,retrospective analysis was performed for 72 children of fecal incontinence after pull-through in HD.They were divided into three groups of excellent (n=41),medium (n=22) and poor efficacy (n=9).Personal demographics,clinical signs and anorectal manometry were compared among three groups.The influncing factors of biofeedback therapeutic efficacy of fecal incontinence were examined by univariate and multivariate Logistic regression.Results Single variate analysis revealed that classification of disease,supplemental household exercise,course of treatment,Vaizey score,rectal sensory volume threshold (RSVT),rectal rest pressure (RRP),anal rest pressure (ARP),anal diastolic pressure (ADP),anal maximal squeeze pressure(AMSP),anal longest squeeze time (ALST) and coordinated of anal contractions (CAC) were correlated factors of biofeedback therapeutic efficacy of fecal incontinence after pull-through in HD (P<0.05).Multivariate Logistic regression analysis indicated that RSVT,RRP,ARP,ALST and course of treatment were the independent influncing factors of therapeutic efficacy of biofeedback.The area under the curve was 0.862(95%CI=0.771-0.953,P=0.000) with a sensitivity of 71.0% and a specificity of 82.9%.Conclusions RSVT,RRP,ARP,ALST and course of treatment are the independent influncing factors of therapeutic efficacy of biofeedback for fecal incontinence after pull-through in HD.The above logit model may predict the therapeutic efficacy of biofeedback for fecal incontinence after pull-through in HD.And the recommended course of treatment is one week.
参考文献/References:
[1] Kim SH,Cho YH,Kim HY.Assessment of defecation function beyond infantile period for transanal single-stage endorectal pull-through in Hirschsprung disease[J].Ann Surg Treat Res,2021,101(4):231-239.DOI:10.4174/astr.2021.101.4.231.
[2] Huizer V,Wijekoon N,Roorda D,et al.Generic and disease-specific health-related quality of life in patients with Hirschsprung disease:a systematic review and meta-analysis[J].World J Gastroenterol,2022,28(13):1362-1376.DOI:10.3748/wjg.v28.i13.1362.
[3] Cerdán Santacruz C,Cerdán Santacruz DM,Milla Collado L,et al.Multimodal man-agement of fecal incontinence focused on sphincteroplasty:long-term outcomes from a single center case series[J].J Clin Med,2022,11(13):3755.DOI:10.3390/jcm11133755.
[4] Loganathan AK,Mathew AS,Kurian JJ.Assessment of quality of life and functional outcomes of operated cases of Hirschsprung disease in a developing country[J].Pediatr Gastroenterol Hepatol Nutr,2021,24(2):145-153.DOI:10.5223/pghn.2021.24.2.145.
[5] 李文强,李娜,马可,等.直肠肛门疾病术后大便失禁的发生情况及预防和治疗策略[J].中华胃肠外科杂志,2023,26(12):1196-1201.DOI:10.3760/cma.j.cn441530-20231012-00129. Li WQ,Li N,Ma K,et al.Occurrence,precaution and treatment strategies of postopera-tive fecal incontinence in rectal and anal diseases[J].Chin J Gastrointest Surg,2023,26(12):1196-1201.DOI:10.3760/cma.j.cn441530-20231012-00129.
[6] 彭川悦,李明森,李玉玮,等.大便失禁的非手术治疗[J].中华胃肠外科杂志,2023,26(12):1138-1142.DOI:10.3760/cma.j.cn441530-20230908-00083. Peng CY,Li MS,Li YW,et al.Non-surgical treatment for fecal incontinence[J].Chin J Gastrointest Surg,2023,26(12):1138-1142.DOI:10.3760/cma.j.cn441530-20230908-00083.
[7] Mongardini FM,Cozzolino G,Karpathiotakis M,et al.Short-and long-term outcomes of sphincteroplasty for anal incontinence related to obstetric injury:a systematic re-view[J].Updates Surg,2023,75(6):1423-1430.DOI:10.1007/s13304-023-01609-1.
[8] Mekhael M,Kristensen H?,Larsen HM,et al.Transanal irrigation for neurogenic bowel disease,low anterior resection syndrome,faecal incontinence and chronic constipation:a systematic review[J].J Clin Med,2021,10(4):753.DOI:10.3390/jcm10040753.
[9] 丁曙晴.大便失禁的整合医学模式:东西方经验的思考[J].中华胃肠外科杂志,2023,26(12):1122-1125.DOI:10.3760/cma.j.cn441530-20231010-00123. Ding SQ.Integrative medicine for fecal incontinence:reflections on eastern and western experiences[J].Chin J Gastrointest Surg,2023,26(12):1122-1125.DOI:10.3760/cma.j.cn441530-20231010-00123.
[10] Hite M,Curran T.Biofeedback for pelvic floor disorders[J].Clin Colon Rectal Surg,2021,34(1):56-61.DOI:10.1055/s-0040-1714287.
[11] 姚一博,肖长芳,王琛.大便失禁的非手术治疗研究进展[J].结直肠肛门外科,2021,27(5):423-427.DOI:10.19668/j.cnki.issn1674-0491.2021.05.002. Yao YB,Xiao CF,Wang C.Research advances on non-surgical treatment of fecal in-continence[J].J Colorectal Anal Surg,2021,27(5):423-427.DOI:10.19668/j.cnki.issn1674-0491.2021.05.002.
[12] 姚一博,董青军,王琛.大便失禁非手术治疗的分阶段评估和全程管理[J].中华胃肠外科杂志,2023,26(12):1143-1144.DOI:10.3760/cma.j.cn441530-20231023-00143. Yao YB,Dong QJ,Wang C.Staged evaluations and full managements of non-surgical treatment of fecal incontinence[J].Chin J Gastrointest Surg,2023,26(12):1143-1144.DOI:10.3760/cma.j.cn441530-20231023-00143.
[13] Zhang ZQ,Cheng Y,Ju JJ,et al.Analysis of the efficacy of biofeedback for faecal incontinence after surgery for anorectal malformation[J].Ann Med,2022,54(1):2385-2390.DOI:10.1080/07853890.2022.2114607.
[14] Xiang XL,Sharma A,Patcharatrakul T,et al.Randomized controlled trial of home bio-feedback therapy versus office biofeedback therapy for fecal incontinence[J].Neurogas-troenterol Motil,2021,33(11):e14168.DOI:10.1111/nmo.14168.
[15] 王珂珂,宋翠萍,张海洋,等.生物反馈治疗联合盆底肌锻炼对小儿功能性大便失禁的疗效与治疗价值探讨[J].临床小儿外科杂志,2022,21(4):358-363.DOI:10.3760/cma.j.cn101785-202011036-012. Wang KK,Song CP,Zhang HY,et al.Application of biofeedback and pelvic floor ex-ercise in the treatment of functional fecal incontinence in children[J].J Clin Ped Sur,2022,21(4):358-363.DOI:10.3760/cma.j.cn101785-202011036-012.
[16] Verkuijl SJ,Meinds RJ,van der Steeg AFW,et al.Functional outcomes after surgery for total colonic,long-segment,versus rectosigmoid segment Hirschsprung disease[J].J Pediatr Gastroenterol Nutr,2022,74(3):348-354.DOI:10.1097/MPG.0000000000003355.
[17] Roorda D,Verkuijl SJ,Derikx JPM,et al.Did age at surgery influence outcome in pa-tients with Hirschsprung disease? A nationwide cohort study in the Netherlands[J].J Pediatr Gastroenterol Nutr,2022,75(4):431-437.DOI:10.1097/MPG.0000000000003550.
[18] Neuvonen MI,Kyrklund K,Rintala RJ,et al.Bowel function and quality of life after transanal endorectal pull-through for Hirschsprung disease:controlled outcomes up to adulthood[J].Ann Surg,2017,265(3):622-629.DOI:10.1097/SLA.0000000000001695.
[19] Mundet L,Rofes L,Ortega O,et al.Kegel exercises,biofeedback,electrostimulation,and peripheral neuromodulation improve clinical symptoms of fecal incontinence and af-fect specific physiological targets:an randomized controlled trial[J].J Neurogastroenter-ol Motil,2021,27(1):108-118.DOI:10.5056/jnm20013.
[20] Brisighelli G,Macchini F,Consonni D,et al.Continence after posterior sagittal anorec-toplasty for anorectal malformations:comparison of different scores[J].J Pediatr Surg,2018,53(9):1727-1733.DOI:10.1016/j.jpedsurg.2017.12.020.
[21] 赵家伟,郭卫红,陈永卫.3D肛门直肠测压在儿童肛门直肠术后肛管功能评估中的应用[J].中华小儿外科杂志,2022,43(3):274-277.DOI:10.3760/cma.j.cn421158-20210116-00028. Zhao JW,Guo WH,Chen YW.Application of three-dimensional anorectal manometry in postoperative assessment of anorectal function in children after anorectal surgery[J].Chin J Pediatr Surg,2022,43(3):274-277.DOI:10.3760/cma.j.cn421158-20210116-00028.
[22] 中国医师协会肛肠医师分会,中国医师协会肛肠医师分会临床指南工作委员会,中国医师协会肛肠医师分会肛肠动力异常性疾病学组,等.结直肠肛门测压中国专家共识(2023版)[J].中华胃肠外科杂志,2023,26(12):1095-1102.DOI:10.3760/cma.j.cn441530-20230922-00102. Branch of Anorectal Surgery,Clinical Guidelines Committee,Branch of Anorectal Mo-tility Disorders Committee of Colorectal Surgeons,Chinese Medical Doctor Association,et al:Chinese Expert Consensus on Colonic and Anorectal Manometry (2023 Edition)[J].Chin J Gastrointest Surg,2023,26(12):1095-1102.DOI:10.3760/cma.j.cn441530-20230922-00102.
[23] Ladi-Seyedian SS,Sharifi-Rad L,Alimadadi H,et al.Comparative efficacy of transcutaneous functional electrical stimulation with or without biofeedback therapy on functional non-retentive fecal incontinence in children:a randomized clinical trial[J].Dig Dis Sci,2022,67(3):989-996.DOI:10.1007/s10620-021-07012-3.
[24] Yuan YH,Xu MY,Yang HY,et al.The efficacy of biofeedback therapy for the treat-ment of fecal incontinence after soave procedure in children for Hirschsprung’s dis-ease[J].Front Pediatr,2021,9:638120.DOI:10.3389/fped.2021.638120.
[25] 陆立.大便失禁病理生理研究基础及诊疗策略更新现状[J].中华胃肠外科杂志,2023,26(12):1126-1131.DOI:10.3760/cma.j.cn441530-20231008-00122. Lu L.Recent advances in pathophysiology research and update on diagnosis and treat-ment strategies for fecal incontinence[J].Chin J Gastrointest Surg,2023,26(12):1126-1131.DOI:10.3760/cma.j.cn441530-20231008-00122.
[26] Sun R,Dai ZY,Zhang Y,et al.The incidence and risk factors of low anterior resection syndrome (LARS) after sphincter-preserving surgery of rectal cancer:a systematic re-view and meta-analysis[J].Support Care Cancer,2021,29(12):7249-7258.DOI:10.1007/s00520-021-06326-2.
[27] Vasant DH,Solanki K,Balakrishnan S,et al.Integrated low-intensity biofeedback therapy in fecal incontinence:evidence that "good" in-home anal sphincter exercise practice makes perfect[J].Neurogastroenterol Motil,2017,29(1):e12912.DOI:10.1111/nmo.12912.
[28] Urvayl?o?lu AE,Kutlutürkan S,K?l?? D.Effect of Kegel exercises on the prevention of urinary and fecal incontinence in patients with prostate cancer undergoing radiothera-py[J].Eur J Oncol Nurs,2021,51:101913.DOI:10.1016/j.ejon.2021.101913.
[29] Miku? M,Kalafati? D,Vrbani? A,et al.Efficacy comparison between Kegel exercises and extracorporeal magnetic innervation in treatment of female stress urinary inconti-nence:a randomized clinical trial[J].Medicina (Kaunas),2022,58(12):1863.DOI:10.3390/medicina58121863.
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备注/Memo
收稿日期:2024-01-24。
基金项目:河南省科技厅科技攻关(222102310292)
通讯作者:杨合英,Email:fccyanghy2@zzu.edu.cn