Diagnosis and follow-up in constipated children: should we use ultrasound?
Diagnosis and follow-up in constipated children: should we use ultrasound?
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DOI：
10.1016/j.jpedsurg.2010.05.006
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发表时间：
2010-09-01
影响因子：
2.4
通讯作者：
Kosar, Ugur
中科院分区：
文献类型：
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作者：
Karaman, Ayse;Ramadan, Selma Uysal;Kosar, Ugur
目的：方法：对66例便秘患者随机分为便秘组和便秘组，分别进行超声检查，观察其对大直肠和粪便负荷的影响，并对治疗效果进行评价根据罗马III标准，在对照组（n = 35;平均年龄，6.8 ± 2.9岁）和对照组（n = 31;平均年龄，8.4 ± 3.8岁）中进行比较。临床评价后，由2名独立的放射科医生进行盆腔超声检查（US）。在膀胱充盈状态下测量膀胱容量和直肠横径。然后测量直肠直径和直肠前壁厚度，并在膀胱排空的情况下记录直肠和乙状结肠中粪便负荷的存在。结果：2名放射科医师进行超声检查的超声测量值比较，两组间无显著性差异（r = 0.981，P <0.001）。因此，我们相信我们的结果是客观和可重复的。直肠直径与年龄、身高、体重、膀胱容量呈正相关。便秘组的排尿后平均直肠直径（3.02 ± 1.04 cm）比对照组（1.98 ± 0.64 cm）厚（P <0.001）。直肠直径诊断便秘的临界点确定为2.44 cm（敏感性71%;特异性76%;曲线下面积0.825; P <0.001）。便秘患者直肠前壁厚度和粪便负荷均高于正常患者（P <0.001）。治疗一个月后便秘评分和粪便量明显下降（P <0.001），但直肠直径虽有所下降，但仍未达到正常范围（2.71 +/- 0.77厘米）结论超声检查有助于正确诊断和随访。同时也让病人和家属相信治疗需要继续下去。(C)2010年爱思唯尔公司All rights reserved.
Purpose: We investigated the efficacy of ultrasound in determining megarectum and fecal load and the response to treatment in constipation and tried to specify objective criteria in this study.Methods: A total of 66 cases were queried and divided into 2 groups as constipated (n = 35; mean age, 6.8 +/- 2.9 years) and control (n = 31; mean age, 8.4 +/- 3.8 years) according to Rome III criteria. After the clinical evaluation, pelvic ultrasonography (US) was performed by 2 separate radiologists. The bladder capacity and the transverse rectal diameter were measured with a full bladder. Then the rectal diameter and rectal anterior wall thickness were measured, and the presence of fecal load in the rectum and sigmoid colon was recorded with an empty bladder. The examination and ultrasound were repeated after treatment for a month in these patients.Results: Comparison of the US measurements of the 2 radiologists performing the US tests did not show any interobserver difference (r = 0.981; P < .001). We therefore believe our results are objective and reproducible. We found a positive correlation between the rectal diameters and the age, height, weight, and bladder capacity. The posturination mean rectal diameter was thicker in the constipated group (3.02 +/- 1.04 cm) than in the control group (1.98 +/- 0.64 cm) (P < .001). The cutoff point of rectal diameter for a diagnosis of constipation was determined as 2.44 cm (71% sensitive; 76% specific; area under curve, 0.825; P < .001). The rectal anterior wall thickness and fecal load were higher in the constipated patients (P < .001). There was a significant decrease in the constipation score and fecal load after treatment for a month (P < .001), but the rectal diameter had not reached normal limits yet despite the decrease (2.71 +/- 0.77 cm) (P > .05).ConclusionThe use of US helps in making a correct diagnosis and in the follow-up with objective criteria and also convinces the patient and the family that the treatment needs to be continued. (C) 2010 Elsevier Inc. All rights reserved.