背景:脊柱异常的患者经常因粪便和/或尿失禁而挣扎(高达87%和92%,分别),并需要采用协作方法进行肠道管理。
方法:为了定义现有方法并提出最先进的肠道管理,使用Medline/PubMed进行文献检索,谷歌学者,科克伦,和EMBASE数据库,重点关注2013年7月和2023年7月出版的手稿。
结果:脊柱畸形患者直肠和肛管神经支配受损,降低泻药和直肠灌肠的成功率。因此,经肛门冲洗和顺行冲洗在这组患者中被广泛使用。根据脊柱MRI,这些儿童的肠道控制潜力取决于年龄,type,和病变水平。关于肠道管理的转诊,进行对比研究以评估结肠运动和排便,随后进行一系列腹部X线检查以确定结肠排空并调整治疗方案。管理的选择包括泻药,直肠灌肠,经肛门灌溉,顺行冲水,和造口的创造。大约22-71%的患者根据病变的类型和水平实现社交节制。
结论:脊柱异常患者在开始肠道管理之前需要彻底评估其可能的失禁和大便负担。根据患者的年龄确定最佳治疗方案,解剖学,和流动性。应与患者及其护理人员讨论独立肠道方案给药的可能性。
BACKGROUND: Patients with spinal abnormalities often struggle with fecal and/or urinary incontinence (up to 87 and 92%, respectively) and require a collaborative approach to bowel management in conjunction.
METHODS: To define existing approaches and propose state-of-the-art bowel management, a literature search was performed using Medline/PubMed, Google Scholar, Cochrane, and EMBASE databases and focusing on the manuscripts published July 2013 and July 2023.
RESULTS: Patients with spinal anomalies have impaired innervation of the rectum and anal canal, decreasing the success rate from laxatives and rectal enemas. Thus, transanal irrigations and antegrade flushes are widely utilized in this group of patients. Based on spinal MRI, the potential for bowel control in these children depends on age, type, and lesion level. On referral for bowel management, a contrast study is performed to assess colonic motility and evacuation of stool, followed by a series of abdominal X-rays to define colonic emptying and adjust the regimen. The options for management include laxatives, rectal enemas, transanal irrigations, antegrade flushes, and the creation of a stoma. Approximately 22-71% of patients achieve social continence dependent on the type and level of the lesion.
CONCLUSIONS: Patients with spinal anomalies require a thorough assessment for continence potential and stool burden prior to initiation of bowel management. The optimal treatment option is defined according to the patient\'s age, anatomy, and mobility. The likelihood of independent bowel regimen administration should be discussed with the patients and their caregivers.