Bischoff Andrea, Brisighelli Giulia, Dickie Belinda, Frischer Jason, Levitt Marc A, Peña Alberto
International Center for Colorectal and Urogenital Care, Children's Hospital Colorado, Aurora, CO, USA.
Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.
J Pediatr Surg. 2018 Sep;53(9):1742-1747. doi: 10.1016/j.jpedsurg.2017.09.022. Epub 2017 Oct 10.
A protocol to treat idiopathic constipation is presented.
A contrast enema is performed in every patient and, when indicated, patients are initially submitted to a "clean out" protocol. All patients are started on a Senna-based laxative. The initial dosage is empirically determined and adjusted daily, during a one week period, based on history and abdominal radiographs, until the amount of Senna that empties the colon is reached. The management is considered successful when patients empty their colon daily and stop soiling. If the laxatives dose provokes abdominal cramping, distension, and vomiting, without producing bowel movements, patients are considered nonmanageable.
From 2005 to 2012, 215 patients were treated. 121 (56%) were males. The average age was 8.2years (range: 1-20). 160 patients (74%) presented encopresis. 67 patients (32%) needed a clean out. After one week, 181 patients (84%) achieved successful management, with an average Senna dose of 67mg (range: 5-175mg). In 34 patients (16%) the treatment was unsuccessful: 19 were nonmanageable, 3 noncompliant, and 12 continued soiling. At a later follow-up (median: 329days) the success rate for 174 patients was 81%.
We designed a successful protocol to manage idiopathic constipation. The key points are clean out before starting laxatives, individual adjustments of laxative, and radiological monitoring of colonic emptying.
Level IV.
介绍一种治疗特发性便秘的方案。
对每位患者进行对比灌肠，必要时患者最初需接受“清理”方案。所有患者均开始使用基于番泻叶的泻药。初始剂量根据经验确定，并在一周内根据病史和腹部X光片每日调整，直至达到清空结肠所需的番泻叶剂量。当患者每天清空结肠并停止弄脏衣物时，治疗被认为成功。如果泻药剂量引发腹部绞痛、腹胀和呕吐，但未产生排便，则患者被认为难以治疗。
2005年至2012年，共治疗215例患者。其中121例（56%）为男性。平均年龄为8.2岁（范围：1 - 20岁）。160例患者（74%）存在大便失禁。67例患者（32%）需要进行清理。一周后，181例患者（84%）治疗成功，番泻叶平均剂量为67毫克（范围：5 - 175毫克）。34例患者（16%）治疗失败：19例难以治疗，3例不依从，12例继续弄脏衣物。在后续随访（中位数：329天）中，174例患者的成功率为81%。
我们设计了一种成功的特发性便秘治疗方案。关键要点是在开始使用泻药前进行清理、个体化调整泻药以及对结肠排空进行放射学监测。
四级。
