Lei Haiyan,Guo Qin,Wang Haibin,et al.Clinical experience of alcohol sclerotherapy for children with rectal prolapse[J].Journal of Clinical Pediatric Surgery,2025,(07):658-661.[doi:10.3760/cma.j.cn101785-202409077-011]
儿童直肠脱垂酒精硬化注射治疗效果分析
- Title:
- Clinical experience of alcohol sclerotherapy for children with rectal prolapse
- Keywords:
- Rectal Prolapse; Constipation; Therapy; Injections; Child
- 摘要:
- 目的 总结分析直肠脱垂患儿的临床特点和治疗经验,初步评估酒精硬化注射治疗直肠脱垂的疗效。方法 回顾性分析华中科技大学同济医学院附属武汉儿童医院2013年1月至2022年12月住院治疗的直肠脱垂患儿资料。患儿均首选纠正咳嗽、腹泻、便秘等诱因的药物治疗或行为治疗,若上述治疗无效,对年龄≥5岁、年龄＜5岁但脱垂长度≥2 cm或嵌顿超过2次的患儿采取酒精硬化注射治疗,并分析所有患儿的治疗效果。结果 共98例患儿纳入本研究,男72例、女26例,平均年龄3岁10个月。便秘、腹泻、慢性咳嗽、大便失禁、骶椎发育异常、结肠息肉为直肠脱垂的主要合并症。98例中,既往发生急性嵌顿35例。19例因首次嵌顿无法门诊复位而急诊住院的患儿镇静后行手法复位、纠正诱因等保守治疗;余79例采取一次或多次酒精硬化注射治疗,术后均未出现肛周黏膜坏死、皮肤坏死等并发症。采取酒精硬化注射治疗的79例直肠脱垂患儿中,有6例术后2周内再次出现脱垂(复发率7.59%);观察3个月后,4例未再出现脱垂,得到痊愈;1例进行了第2次注射术;1例进行了第2次及第3次注射术。所有患儿门诊及电话随访1~6年,均恢复良好。结论 对采取纠正咳嗽、腹泻、便秘等诱因的药物或行为治疗无效的直肠脱垂患儿而言,酒精硬化注射的安全性及治愈率均较高,效果确切,操作简单,可作为外科治疗的首选。
- Abstract:
- Objective To explore the clinical characteristics of rectal prolapse (RP) in children,summarize its therapeutic experience and determine the efficacy of alcohol sclerotherapy injection for managing RP. Methods From January 2013 to December 2022,the relevant clinical data were retrospectively reviewed for 98 RP children.Initially medications or behavioral therapies were offered at resolving such underlying causes as cough,diarrhea and constipation.If these measures proved ineffective,alcohol sclerotherapy was administered to children aged above 5.For children aged under 5,alcohol sclerotherapy was prescribed if prolapse length was ≥2 cm or if there were over two episodes of incarceration. Results There were 72 boys and 26 girls with an average age of 46 month.Constipation,diarrhea,chronic cough,fecal incontinence,abnormal sacral development and colonic polyps were major comorbidities.And 35 children experienced acute impaction and 19 children were admitted into emergency department due to failed conservative resetting of an initial impaction after sedation with manual reduction and correction of the underlying causes.The remaining 79 cases underwent one or multiple rounds of alcohol sclerotherapy injection and none of them developed such postoperative complications as perianal mucosal necrosis or skin necrosis.Within 2 weeks post-injection,6 cases prolapsed again with a recurrence rate of 7.59%.After 3-month observation,4 cases were cured without any recurrence.A second injection (n=1) and a third injection (n=1) were performed.During a follow-up period of (1-6) month,all cases were clinically cured without any complication. Conclusions For RP children unresponsive to medications or behavioral therapies for cough,diarrhea,and constipation,alcohol sclerotherapy is highly safe and effective with a high curative rate.Its straightforward procedure makes it a preferred first-line surgical approach.
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备注/Memo
收稿日期:2024-9-29。
基金项目:国家自然科学基金(81570466)
通讯作者:杨俊,Email:119064715@qq.com