Malone顺行灌肠在治疗顽固性大便失禁中的应用  

The effect of malone＇s procedure with antegrade irrigation on patients with refractory fecal continence

作　　者：王若义[1] 丁庆光[2] 刘倩[1] 陈维秀[1] 孙小兵[1] 李金良[1] 陈雨历[1] 

机构地区：[1]山东大学第二医院小儿外科,济南250033 [2]山东省济宁市第一人民医院外科

出　　处：《中华小儿外科杂志》2011年第12期903-906,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的Malone顺行灌肠（MACE）是一种对机体损伤较小的手术方式，通过问卷调查的形式来评估其在顽固性大便失禁治疗的临床疗效。方法以2000年1月至2009年12月期间接受MACE治疗的32例患儿为研究对象，临床观察和随访时间平均约3．4fr0，结合李正和Shell的评价项目内容并根据临床实际情况，设计了一张问卷调查，其内容主要包括手术方式、应用情况、术后并发症和临床满意度等方面，通过该问卷综合评价MACE在治疗顽固性大便失禁中的作用。结果32例手术患儿中30例获得随访，患儿总体满意率为83．3％，术后患儿均能独立完成灌肠操作，手术方式和造瘘口部位选择在引起并发症方面进行比较，差异无明显统计学意义（P〉0．05），83．3％患儿术后插管顺利，57％的患儿坚持每日清晨灌肠一次和28％的患儿每日需灌肠两次可以保持肛门清洁。4例患儿术后有时仍有肛周污粪，造瘘口狭窄、瘘口反流、瘘口周围皮炎、腹胀、腹痛等是术后遇到的并发症，但这些并发症发生率较低，经过进一步治疗后可好转。结论MACE具有疗效显著、手术创伤小和副作用少等方面的优点，是治疗顽固性大便失禁的良好方法。Objective The Malone antegrade colonic enema （MACE） procedure is a minimally invasive therapy for refractory fecal continence. The aim of this study was to assess curative efficacy for patients undergoing MACE via questionnaire investigation. Methods Totally 32 children patients underwent MACE due to fractory fecal continence between 2000 and 2009. The follow-up period was averagely 3. 4 years, and all patients filled in the questionnaire form based on scoring system raised by Li-Zheng and Shell. Surgical methods, applications, complications and clinical curative satisfaction as the main content, were involved in questionnaire for evaluation of curative efficacy of MACE. Results 30 patients of all were followed-up after MACE procedure. The clinical satisfaction was 83.3%, and they could administer the enema by themselves. Regarding to the post-operative complications, no significantly statistical difference was seen in procedures with differential techniques and ostomies. 57 percent of patients administered the enema once and 28 percent of patients did twice, aiming to keep anal clearance. 4 patients were complicated with the anal or stoma soiling, stoma stenosis, skin inflammation, abdominal distension or pain. Further treatment made improvement. Conclusions MACE procedure is a reliable, minimally invasive surgery with low morbidity for refractory fecal continence.

关 键 词：大便失禁 手术后并发症 

分 类 号：R726.5[医药卫生—儿科]