Poirier M, Abcarian H, Nelson R
Division of Colorectal Surgery, University of Illinois at Chicago, 1740 West Taylor, Room 2204, Chicago, Illinois 60612, USA.
Dis Colon Rectum. 2007 Jan;50(1):22-8. doi: 10.1007/s10350-006-0732-x.
This study was designed to evaluate patient self-reported outcome of the Malone antegrade continent enema at a single institution in patients suffering from severe defecatory disorders.
A total of 18 patients (15 females; median age, 31 (range, 12-63) years) underwent a Malone antegrade continent enema (August 1999 to September 2004). The Malone antegrade continent enema technique has been previously described; however, in this series emphasis was placed on method appendix tunneling. Patients' charts were reviewed and follow-up telephone interviews were conducted. Indications for Malone antegrade continent enema were chronic constipation (n = 12), intractable fecal incontinence (n = 5), or both (n = 1). The underlying pathology included neurogenic (n = 2), congenital (n = 4), postsurgery-related (n = 4), irritable bowel syndrome (n = 6), and megarectum (n = 2). The appendix (n = 17) or cecum (n = 1) was used as a conduit.
The mean follow-up was 18.5 (range, 3-67) months. Fourteen patients (78 percent) still use the Malone antegrade continent enema routinely and report good functional outcome. Three patients (20 percent) required stoma creation as subsequent alternate treatment. A total of 10 patients experienced 12 complications: 3 perioperative (infections) and 9 postoperative Malone antegrade continent enema use/nonuse complications (4 stomal orifice strictures, 2 fecal impactions, 2 appendiceal perforations, and 1 irrigation catheter knot). No patient experienced leakage from the appendiceal stoma. During the follow-up interval, one patient underwent proctectomy for megarectum. No failures occurred in patients with congenital or neurogenic disorders.
Malone antegrade continent enema is a reasonable option for the treatment of select patients with severe defecation disorders. Good functional patient self-reported outcome was achieved by 78 percent of patients. The social inconvenience of stoma leakage is avoided with appropriate surgical technique. Malone antegrade continent enema is one option that provides a less invasive surgical alternative than colectomy or ileostomy for severe defecation disorders.
本研究旨在评估在单一机构中，接受马龙顺行性可控灌肠术的严重排便障碍患者的自我报告结局。
共有18例患者（15例女性；中位年龄31岁（范围12 - 63岁））接受了马龙顺行性可控灌肠术（1999年8月至2004年9月）。马龙顺行性可控灌肠术的技术此前已有描述；然而，在本系列研究中，重点在于阑尾隧道化方法。查阅了患者病历并进行了随访电话访谈。马龙顺行性可控灌肠术的适应证为慢性便秘（n = 12）、顽固性大便失禁（n = 5）或两者兼具（n = 1）。潜在病理包括神经源性（n = 2）、先天性（n = 4）、术后相关（n = 4）、肠易激综合征（n = 6）和巨直肠（n = 2）。使用阑尾（n = 17）或盲肠（n = 1）作为通道。
平均随访时间为18.5个月（范围3 - 67个月）。14例患者（78%）仍常规使用马龙顺行性可控灌肠术，并报告功能结局良好。3例患者（20%）需要造口作为后续替代治疗。共有10例患者出现12种并发症：3例围手术期并发症（感染）和9例术后马龙顺行性可控灌肠术使用/未使用相关并发症（4例造口狭窄、2例粪嵌塞、2例阑尾穿孔和1例冲洗导管打结）。没有患者出现阑尾造口渗漏。在随访期间，1例患者因巨直肠接受了直肠切除术。先天性或神经源性疾病患者未出现失败病例。
马龙顺行性可控灌肠术是治疗部分严重排便障碍患者的合理选择。78%的患者实现了良好的功能自我报告结局。采用适当的手术技术可避免造口渗漏带来的社交不便。对于严重排便障碍，马龙顺行性可控灌肠术是一种比结肠切除术或回肠造口术侵入性更小的手术选择。
