Woodward Mark N, Foley Peter, Cusick Eleri L
Department of Paediatric Surgery, Bristol Royal Hospital for Children, United Kingdom.
J Pediatr Gastroenterol Nutr. 2004 Jan;38(1):75-8. doi: 10.1097/00005176-200401000-00017.
Surgery is indicated in very few children with intractable functional constipation. A number of operations have been described with unpredictable outcome and significant morbidity. The authors present a series of 10 children who underwent a Hartmann procedure with end colostomy formation.
Preoperative management, in addition to maximum conservative measures, included psychologic referral, rectal biopsy, transit studies, and contrast enemas. A standard Hartmann procedure was performed with on-table rectal washout, formation of a proximal sigmoid colostomy, limited anterior resection of hypertrophic proximal rectosigmoid, and oversewing of the rectal stump.
The series includes 10 pediatric patients (4 female, 6 male), in whom constipation was first reported at a median age of 3 years (range, 2 months-7 years) and surgical referral was made at 8 years (range, 1-14 years). Surgery was performed at a median age of 9.5 years (range, 2-15 years), and the median postoperative stay was 5 days (range, 4-9 days). Complications occurred in four patients (transient mild rectal discharge in 2, stomal prolapse in 1, and an unrelated small bowel obstruction in 1 patient with an additional Mitrofanoff stoma). Median postoperative follow-up was 31 months (range, 9-56 months), and the children and parents were all completely satisfied with the stoma.
Colostomy formation is a potential surgical option for severe functional constipation with low associated morbidity and high patient satisfaction.
对于很少一部分患有顽固性功能性便秘的儿童，手术治疗是有必要的。已经描述了多种手术方式，但其结果不可预测且发病率较高。作者报告了一组10例接受哈特曼手术并形成末端结肠造口术的儿童病例。
除了采取最大程度的保守治疗措施外，术前管理还包括心理咨询、直肠活检、传输功能研究和结肠造影灌肠。采用标准的哈特曼手术，术中进行直肠冲洗，形成近端乙状结肠造口，对肥厚的近端直肠乙状结肠进行有限的前切除术，并缝合直肠残端。
该系列包括10例儿科患者（4例女性，6例男性），便秘首次报告的中位年龄为3岁（范围为2个月至7岁），手术转诊年龄为8岁（范围为1至14岁）。手术的中位年龄为9.5岁（范围为2至15岁），术后中位住院时间为5天（范围为4至9天）。4例患者出现并发症（2例出现短暂轻度直肠排出物，1例出现造口脱垂，1例患有额外米氏造口的患者出现无关的小肠梗阻）。术后中位随访时间为31个月（范围为9至56个月），儿童和家长对造口均完全满意。
结肠造口术是治疗严重功能性便秘的一种潜在手术选择，其相关发病率低且患者满意度高。
