Herndon C D Anthony, Cain Mark P, Casale Anthony J, Rink Richard C
Department of Urology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.
J Urol. 2005 Jul;174(1):299-302. doi: 10.1097/01.ju.0000161215.67278.99.
In situations where the appendix is not available for the Malone antegrade continence enema (MACE) procedure a Yang-Monti channel or a colon flap conduit can be created. We report our experience with colonic flap conduits used for the MACE.
A total of 169 MACE procedures were performed between February 1997 and March 2003. In 11 patients 12 colon flaps or cecal extensions were used to construct the MACE conduit. Diagnoses included myelomeningocele (8 patients), caudal regression (1), sacral agenesis (1) and gunshot wound (1). Mean age at creation of MACE was 11.3 years (range 4.4 to 16.9). Seven cecal flaps, 1 descending colon flap and 4 cecal extension flaps were created.
Average followup was 22.8 months (range 2.6 to 34.6). Indications for colon flap MACE were appendicovesicostomy (6 patients), short appendix (2), shortened mesentery (1), retrocecal appendix (1), prior appendectomy (1) and right hemicolectomy (1). Initially all patients easily catheterized and flushed the MACE once daily. All 11 patients achieved fecal continence. Complications occurred in 3 cases. One obese patient could not visualize the umbilical stoma and it stenosed, requiring conversion to a spiral Monti-MACE. One patient with a cecal extension had development of a false passage, resulting in complete channel stenosis. One patient had development of stomal leakage, which was successfully treated with dextranomer/hyaluronic acid copolymer injection.
A colon flap MACE conduit is a simple technique to provide access to the colon for irrigation. When faced with situations were the appendix is not available for the MACE procedure the colon flap can be a good option.
在无法使用阑尾进行马龙顺行性节制灌肠（MACE）手术的情况下，可以创建杨-蒙蒂通道或结肠瓣导管。我们报告了使用结肠瓣导管进行MACE的经验。
1997年2月至2003年3月期间共进行了169例MACE手术。11例患者使用12个结肠瓣或盲肠延长部构建MACE导管。诊断包括脊髓脊膜膨出（8例）、尾椎退化（1例）、骶骨发育不全（1例）和枪伤（1例）。创建MACE时的平均年龄为11.3岁（范围4.4至16.9岁）。创建了7个盲肠瓣、1个降结肠瓣和4个盲肠延长瓣。
平均随访22.8个月（范围2.6至34.6个月）。结肠瓣MACE的适应证包括阑尾膀胱造口术（6例）、阑尾短小（2例）、肠系膜缩短（1例）、盲肠后阑尾（1例）、既往阑尾切除术（1例）和右半结肠切除术（1例）。最初，所有患者均能轻松插入导管并每天冲洗一次MACE。所有11例患者均实现了大便节制。3例发生并发症。1例肥胖患者无法看到脐部造口，造口狭窄，需要改为螺旋蒙蒂-MACE。1例盲肠延长部患者出现假道，导致通道完全狭窄。1例患者出现造口渗漏，通过注射葡聚糖omer/透明质酸共聚物成功治疗。
结肠瓣MACE导管是一种简单的技术，可为结肠灌洗提供通路。当面临无法使用阑尾进行MACE手术的情况时，结肠瓣可能是一个不错的选择。
