儿童功能性便秘诊断标准的评述与比较

Description and Comparison of Diagnostic Criteria in Childhood Functional Constipation

功能性便秘（FC）是儿童期的常见病、多发病,发病率为3%～5%,占儿童消化道门诊的25%。由于便秘病因的复杂性和多样性特点,客观的物理检查缺乏普遍性特点,对于儿童FC的诊断目前大多依靠症状和查体,但儿童语言发育差,对自身症状表述不清,故对儿童便秘的诊断主要来源于家长的主观评述。国内虽然许多学者对儿童FC进行了一定的研究,但目前尚无关于儿童FC的统一标准,对于儿童FC的诊断还一直采用国外儿童的标准。其中几个比较常用的是传统标准、罗马Ⅱ标准和罗马Ⅲ标准。现拟对上述各标准的特点进行评述,比较各诊断标准对儿童FC诊断的异同,结合应用实例分析其诊断的灵敏度和特异度,探讨其对于诊断儿童FC的实用性和有效性。

Functional constipation （FC） in childhood is characterized by a low defecation frequency in combination with either involuntary loss of stools （encopresis） , passage of large amounts of stool, retentive posturing, or hard and often painful defecation. It represents 3 % - 5% of general pediatric outpatient visits and up to 25% of pediatric gastroenterology consultations. FC is a diagnosis made by history and physical examination. No testing is necessary or desirable. The decision to seek medical care for symptoms arises from a parent＇s or caretaker＇s concern for children. The caretaker＇s threshold for concern varies with his or her experiences and expectations, coping style, and perception of illness, till now there is not an universal native criteria established in spite of much has been done in it. The criteria used are still to draw assistance from the foreign standard,among which the classic criteria,the Rome Ⅱ and Rome Ⅲ criteria are considered commonly used. The purpose of this paper is to descript the several foreign criteria, and to make comparison among them, and to explore their applicability and effectiveness in childhood FC.