Sutcliffe Jonathan R, King Sebastian K, Hutson John M, Cook David J, Southwell Bridget R
Department of General Surgery, Royal Children's Hospital, Melbourne, Australia.
Pediatr Surg Int. 2009 Jun;25(6):465-72. doi: 10.1007/s00383-009-2374-2. Epub 2009 May 6.
Chronic constipation in children is common and produces significant morbidity. Identification of the site of dysmotility in constipation may determine the cause and permit directed management. Scintigraphy differentiates constipated patients with anorectal hold-up from those with colonic slowing. Adults with colonic slowing demonstrate variation in the site of hold-up. However, in children with colonic slowing, variability in the site of hold-up has not been investigated.
The current study aimed to characterise colonic transit patterns in 64 children with chronic idiopathic constipation.
Scintigraphic images were grouped visually by their transit patterns. Intra-observer variation was assessed. Scintigraphic data were analysed quantitatively.
Visual analysis of scintigraphy studies demonstrated normal transit (11/64), anorectal hold-up (7/64) and slow colonic transit (46/64). Transit characteristics in the slow transit group demonstrated three possible subgroups: pancolonic slowing (28/46), discrete hold-up in the transverse colon (10/46) and abnormal small and large bowel transit (8/46). Kappa testing demonstrated consistent characterisation (k = 0.79). Statistical analysis of scintigraphic data demonstrated highly significant differences from normal (P < 0.001) in the subgroups.
Scintigraphy demonstrates three possible transit patterns in children with chronic constipation secondary to slow colonic transit.
儿童慢性便秘很常见，且会导致严重的发病情况。确定便秘中动力障碍的部位可能有助于明确病因并进行针对性治疗。闪烁扫描可区分患有肛门直肠梗阻的便秘患者和结肠传输减慢的患者。结肠传输减慢的成人患者梗阻部位存在差异。然而，对于结肠传输减慢的儿童患者，梗阻部位的变异性尚未得到研究。
本研究旨在描述64例慢性特发性便秘儿童的结肠传输模式。
根据闪烁扫描图像的传输模式进行视觉分组。评估观察者内部的差异。对闪烁扫描数据进行定量分析。
闪烁扫描研究的视觉分析显示正常传输（11/64）、肛门直肠梗阻（7/64）和结肠传输缓慢（46/64）。传输缓慢组的传输特征显示出三种可能的亚组：全结肠传输减慢（28/46）、横结肠离散性梗阻（10/46）以及大小肠传输异常（8/46）。kappa检验显示特征描述一致（k = 0.79）。闪烁扫描数据的统计分析表明，各亚组与正常情况相比差异极显著（P < 0.001）。
闪烁扫描显示，结肠传输缓慢所致慢性便秘儿童存在三种可能的传输模式。
