Paidas C N
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Semin Pediatr Surg. 1997 Nov;6(4):228-34.
Children with anorectal malformations suffer from postoperative fecal incontinence as well as other forms of defecation disorders such as constipation, soiling, and incontinence associated with episodes of diarrhea. Indiscriminate use of laxatives, enemas, and pharmacotherapy is not recommended. Rather, it is possible to systematically diagnose and manage fecal incontinence after reconstruction for anorectal malformations. Three groups of children have been identified: candidates for reoperation, candidates for a bowel management program, and pseudoincontinent children. Postoperative evaluation for fecal incontinence should include accurate identification of the type of anorectal anomaly and knowledge of the original reconstructive procedure. In addition, history, physical examination, and review of radiological studies are mandatory, with detailed attention paid to the status of the striated external sphincter musculature and sacrum. Children then can be managed based on the type of fecal incontinence from which they suffer. Bowel management is successful only when performed in an organized manner, and it is recommended as an outpatient procedure.
患有肛门直肠畸形的儿童术后会出现大便失禁以及其他形式的排便障碍，如便秘、弄脏内裤和与腹泻发作相关的失禁。不建议随意使用泻药、灌肠剂和药物治疗。相反，对于肛门直肠畸形重建术后的大便失禁，可以进行系统的诊断和管理。已确定三组儿童：再次手术的候选者、肠道管理计划的候选者和假性失禁儿童。大便失禁的术后评估应包括准确识别肛门直肠异常的类型以及了解原始重建手术。此外，病史、体格检查和影像学研究回顾是必不可少的，要特别关注横纹肌外括约肌肌肉组织和骶骨的状况。然后可以根据儿童所患大便失禁的类型进行管理。肠道管理只有以有组织的方式进行才会成功，建议作为门诊程序进行。
