Hiệu quả của chương trình quản lý ruột (Bowel Management Program – BMP) ở bệnh nhi rối loạn đại tiện sau phẫu thuật dị dạng hậu môn trực tràng

Anorectal malformations (ARM) represent a critical congenital condition that, despite surgical intervention, frequently leads to persistent defecation disorders (DD) in pediatric patients. These complications significantly impair children's physical health and overall quality of life, underscoring the urgent need for comprehensive and effective management strategies. Bowel management programs (BMPs) have emerged as a promising approach to mitigate these challenges, yet their localized efficacy and the precise role of diagnostic tools like anorectal manometry (ALHMTT) in guiding individualized treatment remain underexplored in many contexts. This study addresses this gap by evaluating the effectiveness of a BMP in children experiencing DD following ARM surgery, focusing on improvements in clinical symptoms, ALHMTT parameters, and patient quality of life.

Bác sĩ nhi khoa, phẫu thuật viên nhi, điều dưỡng chuyên khoa nhi, nhà nghiên cứu về tiêu hóa nhi và các chuyên gia chăm sóc sức khỏe liên quan đến bệnh nhi dị dạng hậu môn-trực tràng và rối loạn đại tiện.

This study investigated the impact of a Bowel Management Program (BMP) on children with defecation disorders (DD) following anorectal malformation (ARM) surgery. The core aim was to assess improvements in clinical symptoms, anorectal manometry (ALHMTT) parameters, and overall quality of life (QoL). A 6-month prospective interventional study involved 44 pediatric patients, aged 4-16, who had undergone ARM surgery and presented with persistent DD. Patients received an individualized BMP, with outcomes measured before and after intervention using clinical symptom assessment, ALHMTT, and the Bai Y QoL scale. Logistic regression analysis was employed to identify factors associated with treatment non-response. The BMP demonstrated significant efficacy. A dramatic increase in “good” or “very good” fecal continence was observed, rising from 0% pre-intervention to 59% post-intervention (p < 0.001). ALHMTT parameters, specifically anorectal resting and squeeze pressures, showed statistically significant improvements (p < 0.001), indicating enhanced sphincter function. Consistently, the quality of life scores improved markedly, with the total score increasing from 7.2 to 9.5 (p < 0.001). Reduced rectal perception (increased Vmax) was identified as a significant predictor of non-response (OR = 18.0; p < 0.05). These findings underscore the effectiveness of BMPs in improving bowel function and enhancing the quality of life for children suffering from defecation disorders post-ARM surgery. The study reinforces the importance of individualized, comprehensive interventions and highlights anorectal manometry as a valuable tool for diagnosis and guiding tailored treatment strategies. The results advocate for broader implementation of such programs in pediatric care settings, particularly in contexts where localized data is still emerging, paving the way for improved long-term outcomes for this vulnerable patient population.