Casale Pasquale, Grady Richard W, Feng Waldo C, Joyner Byron D, Mitchell Michael E
Division of Pediatric Urology, Children's Hospital and Regional Medical Center, University of Washington, Seattle, 98105, USA.
J Urol. 2004 Feb;171(2 Pt 1):817-9. doi: 10.1097/01.ju.0000108821.20709.52.
The use of laparoscopic techniques in the construction of an antegrade continence enema (ACE) channel is evolving as a minimally invasive procedure that attempts to address issues of morbidity commonly associated with the technique as originally described. Because of our experience with "open" ACE construction, we maintain that true fecal continence of the ACE channel requires more than dependence on the appendicocecal sphincteric mechanism. Therefore, we have implemented intracorporeal or extracorporeal suturing to create a reliable continence mechanism.
We retrospectively reviewed 6 patients who underwent laparoscopic ACE and compared the outcome to 20 consecutive conventional open ACE procedures. Outcome measures included operative time, perioperative pain control, length of hospital stay, channel leakage, stenosis and herniation.
There was no significant difference in operative time between the laparoscopic and conventional groups. The laparoscopic approach was associated with decreased postoperative pain and hospital stay. Difference in complication rates for leakage, stenosis and herniation was insignificant.
Laparoscopic ACE, performed either completely intracorporeally or with laparoscopic assistance as described, provides another option in the surgical armamentarium to create an antegrade continence enema with decreased postoperative morbidity.
腹腔镜技术在顺行性可控灌肠（ACE）通道构建中的应用正在不断发展，成为一种微创手术，旨在解决最初描述的该技术通常伴随的发病问题。基于我们在“开放”ACE构建方面的经验，我们认为ACE通道真正的大便节制不仅仅依赖于阑尾盲肠括约肌机制。因此，我们采用体内或体外缝合来创建可靠的节制机制。
我们回顾性分析了6例行腹腔镜ACE手术的患者，并将结果与连续20例传统开放性ACE手术进行比较。观察指标包括手术时间、围手术期疼痛控制、住院时间、通道渗漏、狭窄和疝形成。
腹腔镜组和传统组的手术时间无显著差异。腹腔镜手术方式与术后疼痛减轻和住院时间缩短相关。渗漏、狭窄和疝形成的并发症发生率差异不显著。
完全在体内进行或如所述在腹腔镜辅助下进行的腹腔镜ACE手术，为手术器械库提供了另一种选择，可创建顺行性可控灌肠，降低术后发病率。
