Youssef Nader N, Pensabene Licia, Barksdale Edward, Di Lorenzo Carlo
Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
J Pediatr Surg. 2004 Jan;39(1):73-7. doi: 10.1016/j.jpedsurg.2003.09.007.
The aim of this study was to assess benefit of surgery in the treatment of childhood constipation in children without aganglionosis or anorectal malformations.
Retrospective chart review and follow-up questionnaire of 19 children (10 girls, age 7.6 +/- 3.9 years) who underwent surgery after colonic and anorectal manometry had documented abnormal motility. Children at the time of manometric evaluation had symptoms of intractable constipation a mean of 5.1 +/- 2.5 years. Follow-up questionnaires were administered to caregivers a mean of 11.4 +/- 9.3 months after surgical intervention.
Proximal colonic abnormalities were seen in 2 patients, abnormalities involving the distal colon and rectosigmoid region in 13 patients, pancolonic abnormalities in 2 patients, and incomplete relaxation of the internal anal sphincter in 2 patients. Surgery led to increase in frequency of bowel movements per week (8.1 v 1.9; P <.005), decrease in soiling episodes per week (2.20 v 4.7; P <.01), and decrease in daily use of medications for constipation (0.8 v 2.3; P <.05). Adverse events included skin breakdown at site of ostomy (9%), fecal incontinence after pull-through procedure (13%), and persistent constipation (4.5%). Parents felt that the symptoms after surgery were completely resolved in 89% of patients.
Surgery may be beneficial in the management children with chronic intractable constipation and documented abnormalities in motility.
本研究旨在评估手术治疗无神经节细胞症或肛门直肠畸形儿童的儿童便秘的益处。
对19名儿童（10名女孩，年龄7.6±3.9岁）进行回顾性病历审查和随访问卷调查，这些儿童在结肠和肛门直肠测压显示运动异常后接受了手术。测压评估时，儿童平均有5.1±2.5年的顽固性便秘症状。在手术干预后平均11.4±9.3个月向照料者发放随访问卷。
2例患者出现近端结肠异常，13例患者出现涉及远端结肠和直肠乙状结肠区域的异常，2例患者出现全结肠异常，2例患者出现肛门内括约肌不完全松弛。手术导致每周排便频率增加（8.1比1.9；P<.005），每周污粪发作次数减少（2.20比4.7；P<.01），以及便秘药物每日使用量减少（0.8比2.3；P<.05）。不良事件包括造口部位皮肤破损（9%）、拖出术后大便失禁（13%）和持续性便秘（4.5%）。家长认为89%的患者术后症状完全缓解。
手术可能有助于治疗患有慢性顽固性便秘且测压显示运动异常的儿童。
