Curry J I, Osborne A, Malone P S
Department of Paediatric Urology, Southampton General Hospital, England.
J Pediatr Surg. 1999 Feb;34(2):338-40. doi: 10.1016/s0022-3468(99)90204-x.
BACKGROUND/PURPOSE: The Malone Antegrade Continence enema (MACE) procedure has become commonplace in the treatment of patients with faecal incontinence and constipation. To ascertain its place in paediatric practice, the authors surveyed members of the British Association of Paediatric Surgeons (BAPS) to see if they have performed a MACE and continue to do so. The authors also assessed their indications, success rate, and complications.
Members were asked to give the diagnosis of the patients submitted for surgery before September 1996, the procedure used to constructthe MACE, the rate of failure, and complications encountered.
A total of 300 MACE were reported, and the mean follow-up was 2.4 years. The diagnosis of 273 patients was known: spina bifida, 108; anorectal anomaly, 90; Hirschsprung's disease, 22; constipation, 23; other, 30. The most popular procedure was appendix disconnection and reimplantation. The overall success rate for all diagnoses was 79%. The main complication was stomal stenosis, 30%.
These figures confirm that MACE is a useful operation. Improved patient selection, improvement in techniques, and increasing knowledge regarding continued management should lead to improving results across the country.
背景/目的：马龙顺行性节制灌肠术（MACE）在大便失禁和便秘患者的治疗中已变得很常见。为确定其在儿科实践中的地位，作者对英国小儿外科医生协会（BAPS）的成员进行了调查，以了解他们是否实施过MACE并仍在继续实施。作者还评估了其适应证、成功率和并发症。
要求成员给出1996年9月前接受手术患者的诊断、用于构建MACE的手术方法、失败率以及遇到的并发症。
共报告了300例MACE，平均随访时间为2.4年。已知273例患者的诊断：脊柱裂，108例；肛门直肠畸形，90例；先天性巨结肠，22例；便秘，23例；其他，30例。最常用的手术方法是阑尾离断再植术。所有诊断的总体成功率为79%。主要并发症是造口狭窄，发生率为30%。
这些数据证实MACE是一种有用的手术。改善患者选择、改进技术以及增加对持续管理的认识应能使全国范围内的治疗效果得到改善。
