Huang Yixuan,Liu Zhifeng.Recent advances in the diagnosis and treatment of intractable constipation due to redundant colon in children[J].Journal of Clinical Pediatric Surgery,2022,21(11):1040-1044.[doi:10.3760/cma.j.cn101785-202012016-008]
以难治性便秘为主要表现的儿童结肠冗长症诊断及治疗进展
- Title:
- Recent advances in the diagnosis and treatment of intractable constipation due to redundant colon in children
- Keywords:
- Anorectal Malformations; Constipation; Colonic Diseases
- 摘要:
- 难治性便秘是指经保守治疗3个月无效的胃肠运动障碍性疾病，患儿常并发结肠冗长症。结肠冗长症表现为长期便秘和大量粪便潴留，进而造成肠道蠕动障碍，严重影响患儿生长发育及生活质量。通过灌肠造影可判断结肠定位及形态是否异常，结肠传输试验、肛门直肠测压、结肠测压、组织病理学检查可辅助诊断难治性便秘。目前，以难治性便秘为主要表现的结肠冗长症如长期保守治疗无效，应采取顺行节制性灌肠、骶神经刺激以及手术治疗。本文对以难治性便秘为主要表现的儿童结肠冗长症的诊断与治疗进展进行综述。
- Abstract:
- Children of intractable constipation present frequently with dilated and redundant colon leading to long-term fecal impaction and not responding to conventional treatments for over 3 months.As a result, bowel loses normal function.Intractable constipation may adversely affect the growth, development and even quality-of-life.In conjunctions with contrast enema for determining whether or not colon location and morphological changes are abnormal, colonic transit time, anorectal manometry, colonic manometry and pathological findings aid in differentiating bowel movement disorders for individualized comprehensive managements.If medically unmanageable, antegrade continence enema (ACE), sacral nerve stimulation (SNS) and surgical interventions may be adopted.
参考文献/References:
[1] 刘永东, 胡强, 李俊峰, 等.14例小儿乙状结肠冗长症手术治疗分析[J].临床小儿外科杂志, 2015, 14(4):345-346.DOI:10.3969/j.issn.1671-6353.2015.04.029. Liu YD, Hu Q, Li JF, et al.Analyses of surgical treatment of 14 cases of dolichosigmoid in children[J].J Clin Ped Sur, 2015, 14(4):345-346.DOI:10.3969/j.issn.1671-6353.2015.04.029.
[2] Koppen IJN, Kuizenga-Wessel S, Lu PL, et al.Surgical decision-making in the management of children with intractable functional constipation:what are we doing and are we doing it right?[J].J Pediatr Surg, 2016, 51(10):1607-1612.DOI:10.1016/j.jpedsurg.2016.05.023.
[3] Tabbers MM, DiLorenzo C, Berger MY, et al.Evaluation and treatment of functional constipation in infants and children:evidence-based recommendations from ESPGHAN and NASPGHAN[J].J Pediatr Gastroenterol Nutr, 2014, 58(2):258-274.DOI:10.1097/MPG.0000000000000266.
[4] Cheng LS, Goldstein AM.Surgical management of idiopathic constipation in pediatric patients[J].Clin Colon Rectal Surg, 2018, 31(2):89-98.DOI:10.1055/s-0037-1609023.
[5] Paknejad MS, Motaharifard MS, Barimani S, et al.Traditional, complementary and alternative medicine in children constipation:a systematic review[J].Daru, 2019, 27(2):811-826.DOI:10.1007/s40199-019-00297-w.
[6] El-Sonbaty MM, Fathy A, Aljohani A, et al.Assessment of behavioural disorders in children with functional constipation[J].Open Access Maced J Med Sci, 2019, 7(23):4019-4022.DOI:10.3889/oamjms.2019.677.
[7] Wood RJ, Yacob D, Levitt MA.Surgical options for the management of severe functional constipation in children[J].Curr Opin Pediatr, 2016, 28(3):370-379.DOI:10.1097/MOP.0000000000000345.
[8] Raahave D.Dolichocolon revisited:an inborn anatomic variant with redundancies causing constipation and volvulus[J].World J Gastrointest Surg, 2018, 10(2):6-12.DOI:10.4240/wjgs.v10.i2.6.
[9] Koppen IJN, Thompson BP, Ambeba EJ, et al.Segmental colonic dilation is associated with premature termination of high-amplitude propagating contractions in children with intractable functional constipation[J].Neurogastroenterol Motil, 2017, 29(10):1-9.DOI:10.1111/nmo.13110.
[10] Radwan AB, El-Debeiky MS, Abdel-Hay S.Contrast enema as a guide for senna-based laxatives in managing overflow retentive stool incontinence in pediatrics[J].Pediatr Surg Int, 2015, 31(8):765-771.DOI:10.1007/s00383-015-3741-9.
[11] 黄国强, 魏小巍.结肠冗长症研究现状及治疗新进展[J].世界最新医学信息文摘, 2017, 17(40):44, 46. Huang GQ, Wei XW.Current research status and new treatment progress of redundant colon[J].World Latest Med Inf, 2017, 17(40):44, 46.
[12] 胡波, 张开晓.外科治疗结肠冗长症的心得体会[J].世界最新医学信息文摘, 2019, 19(45):317, 320.DOI:10.19613/j.cnki.1671-3141.2019.45.227. Hu B, Zhang KX.Surgical experiences of redundant colon[J].World Latest Med Inf, 2019, 19(45):317, 320.DOI:10.19613/j.cnki.1671-3141.2019.45.227.
[13] 许芝林, 王强, 李琰, 等.乙状结肠冗长症的术式选择探讨[J].临床小儿外科杂志, 2010, 9(6):432-434.DOI:10.3969/j.issn.1671-6353.2010.06.010. Xu ZL, Wang Q, Li Y, et al.Selecting surgical approaches for dolichosigmoid[J].J Clin Ped Sur, 2010, 9(6):432-434.DOI:10.3969/j.issn.1671-6353.2010.06.010.
[14] Koppen IJN, Yacob D, Di Lorenzo C, et al.Assessing colonic anatomy normal values based on air contrast enemas in children younger than 6 years[J].Pediatr Radiol, 2017, 47(3):306-312.DOI:10.1007/s00247-016-3746-0.
[15] Li YW, Yu YJ, Fei F, et al.High-resolution colonic manometry and its clinical application in patients with colonic dysmotility:a review[J].World J Clin Cases, 2019, 7(18):2675-2686.DOI:10.12998/wjcc.v7.i18.2675.
[16] Hutson JM, Hynes MC, Kearsey I, et al.’Rapid transit’ constipation in children:a possible genesis for irritable bowel syndrome[J].Pediatr Surg Int, 2020, 36(1):11-19.DOI:10.1007/s00383-019-04587-x.
[17] Benninga MA, Faure C, Hyman PE, et al.Childhood functional gastrointestinal disorders:neonate/toddler[J].Gastroenterology, 2006, 150(6):1443-1455.E2.DOI:10.1053/j.gastro.2016.02.016.
[18] 苗绘, 许芝林, 任冬晗, 等.单纯乙状结肠冗长症患儿术前及术后的肛门直肠测压分析[J].中华临床医师杂志(电子版), 2011, 5(21):6463-6465.DOI:10.3877/cma.j.issn.1674-0785.2011.21.051. Miao H, Xu ZL, Ren DH, et al.Analysis of anorectal manometry before and after surgery in children with dolichosigmoid[J].Chin J Clin (Electron Ed), 2011, 5(21):6463-6465.DOI:10.3877/cma.j.issn.1674-0785.2011.21.051.
[19] O’Dwyer RH, Acosta A, Camilleri M, et al.Clinical features and colonic motor disturbances in chronic megacolon in adults[J].Dig Dis Sci, 2015, 60(8):2398-2407.DOI:10.1007/s10620-015-3645-5.
[20] Wu XJ, Zhang HY, Li N, et al.A new diagnostic scoring system to differentiate Hirschsprung’s disease from Hirschsprung’s disease-allied disorders in patients with suspected intestinal dysganglionosis[J].Int J Colorectal Dis, 2013, 28(5):689-696.DOI:10.1007/s00384-013-1691-z.
[21] Andromanakos NP, Pinis SI, Kostakis AI.Chronic severe constipation:current pathophysiological aspects, new diagnostic approaches, and therapeutic options[J].Eur J Gastroenterol Hepatol, 2015, 27(3):204-214.DOI:10.1097/MEG.0000000000000288.
[22] Wessel S, Koppen IJN, Wiklendt L, et al.Characterizing colonic motility in children with chronic intractable constipation:a look beyond high-amplitude propagating sequences[J].Neurogastroenterol Motil, 2016, 28(5):743-757.DOI:10.1111/nmo.12771.
[23] Corsetti M, Costa M, Bassotti G, et al.First translational consensus on terminology and definitions of colonic motility in animals and humans studied by manometric and other techniques[J].Nat Rev Gastroenterol Hepatol, 2019, 16(9):559-579.DOI:10.1038/s41575-019-0167-1.
[24] Gupta A, Basson S, Borrelli O, et al.Surgically treated intractable constipation in children evaluated with colonic manometry[J].J Pediatr Surg, 2020, 55(2):265-268.DOI:10.1016/j.jpedsurg.2019.10.046.
[25] Ohkubo H, Masaki T, Matsuhashi N, et al.Histopathologic findings in patients with idiopathic megacolon:a comparison between dilated and non-dilated loops[J].Neurogastroenterol Motil, 2014, 26(4):571-580.DOI:10.1111/nmo.12303.
[26] Wang XJ, Camilleri M.Chronic megacolon presenting in adolescents or adults:clinical manifestations, diagnosis, and genetic associations[J].Dig Dis Sci, 2019, 64(10):2750-2756.DOI:10.1007/s10620-019-05605-7.
[27] Cuda T, Gunnarsson R, De Costa A.Symptoms and diagnostic criteria of acquired megacolon-a systematic literature review[J].BMC Gastroenterol, 2018, 18(1):25.DOI:10.1186/s12876-018-0753-7.
[28] Keller J, Bassotti G, Clarke J, et al.Expert consensus document:advances in the diagnosis and classification of gastric and intestinal motility disorders[J].Nat Rev Gastroenterol Hepatol, 2018, 15(5):291-308.DOI:10.1038/nrgastro.2018.7.
[29] 陶桢, 蒋学武, 李建宏.小儿乙状结肠冗长症21例诊治分析[J].临床小儿外科杂志, 2006, 5(5):328-330.DOI:10.3969/j.issn.1671-6353.2006.05.003. Tao Z, Jiang XW, Li JH.Clinical analyses of diagnosing and treating 21 cases of dolichosigmoid in children[J].J Clin Ped Sur, 2006, 5(5):328-330.DOI:10.3969/j.issn.1671-6353.2006.05.003.
[30] Rodriguez L, Sood M, Di Lorenzo C, et al.An ANMS-NASPGHAN consensus document on anorectal and colonic manometry in children[J].Neurogastroenterol Motil, 2017, 29(1):e12944.DOI:10.1111/nmo.12944.
[31] Halleran DR, Vilanova-Sanchez A, Rentea RM, et al.A comparison of Malone appendicostomy and cecostomy for antegrade access as adjuncts to a bowel management program for patients with functional constipation or fecal incontinence[J].J Pediatr Surg, 2019, 54(1):123-128.DOI:10.1016/j.jpedsurg.2018.10.008.
[32] Dolejs SC, Smith JK, Jr, Sheplock J, et al.Contemporary short- and long-term outcomes in patients with unremitting constipation and fecal incontinence treated with an antegrade continence enema[J].J Pediatr Surg, 2017, 52(1):79-83.DOI:10.1016/j.jpedsurg.2016.10.022.
[33] Chong C, Featherstone N, Sharif S, et al.5 years after an ACE:what happens then?[J].Pediatr Surg Int, 2016, 32(4):397-401.DOI:10.1007/s00383-016-3857-6.
[34] Vriesman MH, Wang L, Park C, et al.Comparison of antegrade continence enema treatment and sacral nerve stimulation for children with severe functional constipation and fecal incontinence[J].Neurogastroenterol Motil, 2020, 32(8):e13809.DOI:10.1111/nmo.13809.
[35] Glasser JG, Nottingham JM, Durkin M, et al.Case series with literature review:surgical approach to megarectum and/or megasigmoid in children with unremitting constipation[J].Ann Med Surg (Lond), 2018, 26:24-29.DOI:10.1016/j.amsu.2017.12.009.
[36] Rodriguez L, Heinz N, Nurko S.Utility of colon manometry in guiding therapy and predicting need for surgery in children with defecation disorders[J].J Pediatr Gastroenterol Nutr, 2020, 70(2):232-237.DOI:10.1097/MPG.0000000000002504.
[37] Siminas S, Losty PD.Current surgical management of pediatric idiopathic constipation:a systematic review of published studies[J].Ann Surg, 2015, 262(6):925-933.DOI:10.1097/SLA.0000000000001191.
[38] Cuda T, Gunnarsson R, De Costa A.The correlation between diverticulosis and redundant colon[J].Int J Colorectal Dis, 2017, 32(11):1603-1607.DOI:10.1007/s00384-017-2894-5.
[39] Kerur B, Kantekure K, Bonilla S, et al.Management of chronic intractable constipation in children[J].J Pediatr Gastroenterol Nutr, 2014, 59(6):754-757.DOI:10.1097/MPG.0000000000000535.
[40] Kuizenga-Wessel S, Koppen IJN, Zwager LW, et al.Surgical management of children with intractable functional constipation;experience of a single tertiary children’s hospital[J].Neurogastroenterol Motil, 2017, 29(5):e13005.DOI:10.1111/nmo.13005.
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备注/Memo
收稿日期:2020-12-06。
基金项目:南京市卫生科技发展专项资金项目（ZKX20042）
通讯作者:刘志峰,Email:zfliu@njmu.edu.cn