УЛЬТРАЗВУКОВАЯ ДИАГНОСТИКА ХРОНИЧЕСКОГО ЗАПОРА У ДЕТЕЙ: РЕЗУЛЬТАТЫ КЛИНИЧЕСКОГО ИССЛЕДОВАНИЯ

Abstract

Chronic constipation (CC) is an important medical and social problem, as it can lead to the development of complications, fecal intoxication, social disadaptation and self-isolation of a child, as well as significantly reduce the quality of life. The article presents the results of a clinical study of CC in children using a new diagnostic method - transabdominal and transperianal ultrasound examination (US) of the colon and anorectal zone. The objective of the study was to analyze the course of CC in children depending on the mechanism of its formation according to US of the colon and anorectal zone. Materials and methods of research: the prospective cohort study included 470 children with an established diagnosis of CC at the age of 1 month to 17 years old. The patients were divided into 3 age groups: 1 month. – 3 years (n=166), 4–10 years (n=102), 11–17 years (n=202). The median follow-up was 48 months. The age distribution of children with CC was carried out on the basis of the frequency of visits, against the background of the beginning of attending kindergarten and/or elementary school groups, and the emergence of psychological problems due to the difficulty of going to a public toilet. An evaluation of analysis of the dynamics of US changes in the colon and anorectal zone was carried out by the method of ultrasound diagnosis of Hirschsprung's disease in children (patent № 2547614, authors M.I. Pykov, M.M. Kolisnichenko, I.V. Poddubny). Results: in children aged 1 month to 3 years, 66.9% of cases are statistically significantly dominated by proctogenic constipation type of constipation with US signs of anus spasm and anal sphincter insufficiency. In children aged 4 to 10 years, the mixed mechanism of CC formation prevails (41.1%), and in patients aged 11 to 17 years – cologenic (77.7%), for which the most typical ultrasound signs are dolichocolon (22.8%), anus spasm (8.7%), anal sphincter insufficiency (4.7%). It has been established that despite adequate therapy, the number of patients with the above-described mechanisms of formation of CC increases, which indicates the recurrence and progression of pathological process in children of different age groups. Conclusion: the proposed diagnostic method – transabdominal and transperianal US of the colon and anorectal zone is a highly informative, pathogenetically substantiated method for examining the state of the colon and anorectal zone in children with CC, built on precise objective criteria that are available at any age.