Cheng Lily S, Goldstein Allan M
Department of General Surgery, University of California San Francisco, San Francisco, California.
Department of Surgery, Harvard Medical School, Boston, Massachusetts.
Clin Colon Rectal Surg. 2018 Mar;31(2):89-98. doi: 10.1055/s-0037-1609023. Epub 2018 Feb 25.
Constipation is a common childhood problem, but an anatomic or physiologic cause is identified in fewer than 5% of children. By definition, idiopathic constipation is a diagnosis of exclusion. Careful clinical evaluation and thoughtful use of imaging and other testing can help exclude specific causes of constipation and guide therapy. Medical management with laxatives is effective for the majority of constipated children. For those patients unresponsive to medications, however, several surgical options can be employed, including anal procedures, antegrade colonic enemas, colorectal resection, and intestinal diversion. Judicious use of these procedures in properly selected patients and based on appropriate preoperative testing can lead to excellent outcomes. This review summarizes the surgical options available for managing refractory constipation in children and provides guidance on how to choose the best procedure for a given patient.
便秘是儿童常见的问题，但不到5%的儿童能找到解剖学或生理学原因。根据定义，特发性便秘是一种排除性诊断。仔细的临床评估以及合理运用影像学和其他检查有助于排除便秘的特定原因并指导治疗。对大多数便秘儿童而言，使用泻药进行药物治疗是有效的。然而，对于那些对药物无反应的患者，可以采用几种手术方法，包括肛门手术、顺行结肠灌肠、结直肠切除术和肠道改道。在适当选择的患者中并基于适当的术前检查明智地使用这些手术方法可带来良好的效果。本综述总结了可用于治疗儿童难治性便秘的手术方法，并就如何为特定患者选择最佳手术提供指导。
