Hirst G R, Arumugam P J, Watkins A J, Mackey P, Morgan A R, Carr N D, Beynon J
Colorectal Unit, Singleton Hospital, Swansea, UK.
Tech Coloproctol. 2005 Dec;9(3):217-21. doi: 10.1007/s10151-005-0230-5. Epub 2005 Nov 21.
Obstructed defaecation and faecal incontinence are complex functional disorders that pose management challenges. In recent times, the antegrade continence enema (ACE) has been tried both as a primary procedure and as a final resort to avoid a colostomy in patients with a variety of functional problems. The purpose of this study was to evaluate the role of the ACE procedure as a treatment option for adult patients suffering from obstructed defaecation with or without faecal incontinence, some of whom also had slow transit constipation.
Twenty female patients underwent ACE as an appendicostomy (65%) or caecostomy (35%). The median age was 44 years (range, 20-65 years). The indications were obstructed defaecation with faecal incontinence (65%) and obstructed defaecation alone (35%). Fifteen of these patients were followed for 3-51 months (median, 6 months). Cleveland continence score, bowel score and quality of life score were recorded pre- and postoperatively along with post-procedure complications.
Thirteen (65%) patients were satisfied with the outcome and recorded improvement in their scores while two (10%) remained the same and one (5%) was worse. This latter woman and another patient stopped using their ACE, whilst follow-up data was unavailable for three patients. Minor wound infections were noted in nine patients (45%), of whom one needed drainage of an abscess; the rest settled with antibiotics and dressings. Bowel and Cleveland continence scores improved postoperatively (p<0.001 and p=0.001, respectively) but SF36 scores did not. To date, no patient has had a colostomy following an ACE procedure.
Colostomies can be avoided in patients with obstructed defaecation. There is, however, a need to minimise wound infections which seem to be the most troublesome complication.
排便梗阻和大便失禁是复杂的功能性疾病，给治疗带来挑战。近年来，顺行性节制灌肠术（ACE）已被尝试作为主要治疗方法以及在患有各种功能性问题的患者中作为避免结肠造口术的最后手段。本研究的目的是评估ACE手术作为患有或不患有大便失禁的排便梗阻成年患者的一种治疗选择的作用，其中一些患者还患有慢传输型便秘。
20名女性患者接受了作为阑尾造口术（65%）或盲肠造口术（35%）的ACE手术。中位年龄为44岁（范围20 - 65岁）。适应证为伴有大便失禁的排便梗阻（65%）和单纯排便梗阻（35%）。其中15名患者随访了3 - 51个月（中位时间6个月）。记录术前和术后的克利夫兰控便评分、肠道评分和生活质量评分以及术后并发症。
13名（65%）患者对结果满意，评分有所改善，2名（10%）患者评分不变，1名（5%）患者评分变差。后一名女性患者和另一名患者停止使用其ACE，3名患者没有随访数据。9名患者（45%）出现轻微伤口感染，其中1名需要引流脓肿；其余患者通过抗生素和换药治愈。术后肠道和克利夫兰控便评分有所改善（分别为p<0.001和p = 0.001），但SF36评分未改善。迄今为止，没有患者在ACE手术后进行结肠造口术。
排便梗阻患者可避免行结肠造口术。然而，需要尽量减少伤口感染，这似乎是最麻烦的并发症。
