Heymans H S, Benninga M A, de Groot I, Strubbe W, Büller H A
Academisch Ziekenhuis Beatrix Kinderkliniek, afd. Kindergeneeskunde, Groningen.
Ned Tijdschr Geneeskd. 1993 Apr 3;137(14):721-4.
In 87 children with constipation an assessment was made of the causes, and of the effect of treatment. Two subdivisions were made, one by age (< 3 years and > or = 3 years) and the second into 'own' or 'referred' patients. For the 59 own children a diagnostic-therapeutic protocol was used, the three-phase protocol. For children over 3 years (n = 29) this policy consists in the first phase of anamnesis, physical examination, diet and oral and/or rectal laxatives. In the second phase, toilet training is administered in combination with diet and oral laxatives. The third phase comprises continuation of the diet and tapering off of the laxatives. If no improvement is seen, supplementary examination is carried out. In the group of own patients younger than 3 years, supplementary examination is already carried out during the first phase. Functional constipation was diagnosed in 69% and 98%, respectively, of the 36 patients under 3 years and the 51 over 3 years. Hirschsprung's disease was diagnosed in 14% and 2%, respectively. In the children > or = 3 years with functional constipation the three-phase policy was successful in 86% with a mean duration of the treatment of 9.5 months. The efficiency of diagnostic examination of children over 3 years appears to be low, justifying the proposed three-phase policy. In children under 3 years, on the other hand, limited laboratory examination is necessary during the first phase. Examination for the presence of Hirschsprung's disease, by means of rectal biopsy or anorectal manometry is indicated if the treatment during the first phase is unsuccessful.
对87名便秘患儿的病因及治疗效果进行了评估。将患儿分为两组，一组按年龄划分（<3岁和≥3岁），另一组按“自身就诊”或“转诊”划分。对于59名自身就诊的患儿，采用了诊断 - 治疗方案，即三相方案。对于3岁以上的患儿（n = 29），该方案的第一阶段包括问诊、体格检查、饮食调整以及口服和/或直肠泻药治疗。第二阶段，结合饮食调整和口服泻药进行排便训练。第三阶段包括继续饮食调整并逐渐减少泻药用量。若未见改善，则进行补充检查。在3岁以下的自身就诊患儿组中，第一阶段即进行补充检查。3岁以下的36名患儿和3岁以上的51名患儿中，功能性便秘的诊断率分别为69%和98%。先天性巨结肠的诊断率分别为14%和2%。在≥3岁的功能性便秘患儿中，三相方案的成功率为86%，平均治疗时长为9.5个月。3岁以上患儿的诊断检查效率似乎较低，这证明了所提议的三相方案的合理性。另一方面，对于3岁以下的患儿，第一阶段进行有限的实验室检查即可。若第一阶段治疗不成功，则需通过直肠活检或肛门直肠测压检查是否存在先天性巨结肠。
