Wong Andrew L, Kravarusic Dragan, Wong Sarah L
Pediatric Surgery Department, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
J Pediatr Surg. 2008 Aug;43(8):1445-51. doi: 10.1016/j.jpedsurg.2007.12.051.
In childhood and adolescence, fecal soiling represents a psychologically devastating problem. Physical and emotional distress associated with daily rectal enemas is minimized by the introduction of a cecostomy tube for colonic cleansing with antegrade colonic enemas (ACEs).
Over a period of 10 years (1997-2007), we performed "button" cecostomies in 69 pediatric patients with fecal soiling secondary to a variety of disorders; laparoscopic procedures were performed in 40 and open procedures in 29. Mean postoperative follow-up was 4.03 SD +/- 1.76 years. Cleansing protocols differed between patients.
We adopted a standardized questionnaire concerning management of incontinence/intractable constipation before and after button cecostomy insertion to assess the long-term impact of ACE on symptom severity and quality of life. Complications included tube dislodgement (n = 9), development of granulation tissue (n = 11), decubitus ulcer (n = 5), and infection (n = 3). Patient/parents satisfaction (appraisal scale 1-3) and improvement of quality of life achieved statistical significance for both (P < .001).
Since button cecostomy and ACE were introduced in our institution as a management option, the treatment of fecal incontinence and intractable constipation significantly improved in terms of efficacy and patient compliance and also resulted in greater patient and parent satisfaction.
在儿童和青少年时期，大便失禁是一个会对心理造成严重伤害的问题。通过引入盲肠造瘘管进行顺行结肠灌肠（ACE）来清洁结肠，可将与每日直肠灌肠相关的身体和情绪困扰降至最低。
在10年期间（1997 - 2007年），我们对69例因各种疾病导致大便失禁的儿科患者进行了“纽扣”式盲肠造瘘术；其中40例采用腹腔镜手术，29例采用开放手术。术后平均随访时间为4.03标准差±1.76年。不同患者的清洁方案有所不同。
我们采用了一份关于插入纽扣式盲肠造瘘管前后大小便失禁/顽固性便秘管理的标准化问卷，以评估ACE对症状严重程度和生活质量的长期影响。并发症包括导管移位（n = 9）、肉芽组织形成（n = 11）、褥疮（n = 5）和感染（n = 3）。患者/家长满意度（评估量表1 - 3）和生活质量改善在两者中均达到统计学显著水平（P < .001）。
自从在我们机构引入纽扣式盲肠造瘘术和ACE作为一种治疗选择以来，大便失禁和顽固性便秘的治疗在疗效和患者依从性方面有了显著改善，同时也提高了患者和家长的满意度。
