Schmittenbecher P P, Schmidt A, Joppich I
Kinderchirurgische Klinik im Dr. v. Haunerschen Kinderspital, Ludwig-Maximilians-Universität München.
Kinderarztl Prax. 1993 Oct;61(7-8):250-7.
Paediatric surgeons are engaged in different causes of chronic constipation. Aganglionosis usually needs surgical therapy, but in dysganglionosis a distinct differentiation is necessary between patients sufficiently treated by conservative methods and others requiring surgery. Sometimes the operation seems to be an "ultima ratio" in these patients. Otherwise surgery can be necessary early in enterocolitis, ileus or toxic megacolon. In the spectrum of anal malformations constipation may be a primary symptom (anal ectopia, anal stenosis, low anal atresia with anocutaneous fistula) or appears as a post-operative complication (intermediate or high anal atresia). In secondary megacolon, surgery is performed to remove the result of therapeutic negation over many years. The operation may be the supposition to follow up with conservative treatment. In the management of constipated patients an exact diagnostic clarification has a central position. This especially includes anorectal manometry, x-ray examination with contrast medium application and defaecography and as last rectal biopsy.
小儿外科医生会处理不同病因导致的慢性便秘。无神经节症通常需要手术治疗，但在神经节发育异常的情况下，对于通过保守方法得到充分治疗的患者和需要手术的患者，必须进行明确区分。有时手术似乎是这些患者的“最终手段”。此外，在小肠结肠炎、肠梗阻或中毒性巨结肠的早期可能需要进行手术。在肛门畸形的范畴内，便秘可能是主要症状（肛门异位、肛门狭窄、低位肛门闭锁伴肛门皮肤瘘）或表现为术后并发症（中位或高位肛门闭锁）。在继发性巨结肠中，手术是为了消除多年治疗不力的后果。手术可能是后续保守治疗的前提。在便秘患者的管理中，准确的诊断性明确具有核心地位。这尤其包括肛门直肠测压、应用造影剂的X线检查、排粪造影以及最后的直肠活检。
