Lynch A C, Beasley S W, Robertson R W, Morreau P N
Departments of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand, and Princess Margaret Hospital, Perth, Australia.
Pediatr Surg Int. 1999 Jul;15(5-6):343-6. doi: 10.1007/s003830050595.
Several modifications of the Malone antegrade continence enema (ACE) procedure have now been reported. In this study we have compared the results of our experience with the laparoscopic appendicostomy (LACE procedure) with the published results of previously described open ACE procedures. Children who had the LACE procedure at our institutions were reviewed. Intra- and postoperative problems were identified by review of hospital case notes and from a questionnaire completed by the children's caregivers. These results were compared with the reported results of the original Malone procedure, the Peña modification, and the open appendicostomy as described by Wilcox. Since 1994, 30 children have had LACE procedures performed at our institutions. Two have required conversion to an open procedure because of difficulty locating the appendix. The stoma is being used for regular antegrade colonic washouts in 29 of the 30, compared with 19 of 31 in Malone's series and 16 of 20 in Peña's. Improvement in soiling has been achieved in 27 (90%) of our patients, 15 of whom are completely clean, a rate similar to that of the other types of procedure (61%-78%). Stenosis of the stoma has occurred in 8 children (27%), compared with rates of 10%-33% in other series. Stomal leakage has been troublesome for 2 (6.7%), compared with leak rates between 5.6% and 15% in other series. The LACE procedure is technically the simplest. The laparoscopic approach to the ACE procedure appears to be a simpler and safe alternative to previously described methods. It causes minimal morbidity, has a high long-term viability rate, and resulted in improved control of soiling in 90% of the children with faecal incontinence in whom it has been employed.
目前已有多种对马龙顺行性节制灌肠术（ACE）的改良方法被报道。在本研究中，我们将腹腔镜阑尾造口术（LACE手术）的经验结果与先前描述的开放性ACE手术的已发表结果进行了比较。对在我们机构接受LACE手术的儿童进行了回顾性研究。通过查阅医院病历和儿童护理人员填写的问卷来确定术中及术后问题。将这些结果与原始马龙手术、佩尼亚改良手术以及威尔科克斯所描述的开放性阑尾造口术的报道结果进行比较。自1994年以来，我们机构有30名儿童接受了LACE手术。其中2例因阑尾定位困难而需要转为开放性手术。30例中有29例的造口用于定期顺行性结肠冲洗，相比之下，马龙系列中的31例中有19例，佩尼亚系列中的20例中有16例。我们的27例（90%）患者的污粪情况得到改善，其中15例完全清洁，这一比例与其他类型手术相似（61%-78%）。8例儿童（27%）出现造口狭窄，其他系列的发生率为10%-33%。2例（6.7%）出现造口渗漏问题，其他系列的渗漏率在5.6%至15%之间。LACE手术在技术上是最简单的。腹腔镜下的ACE手术似乎是一种比先前描述的方法更简单、安全的替代方法。它引起的发病率极低，长期存活率高，并且在90%接受该手术的大便失禁儿童中改善了对污粪的控制。
