Sinha C K, Butler C, Haddad M
Department of Paediatric Surgery, Chelsea & Westminster Hospital, London, United Kingdom.
Eur J Pediatr Surg. 2008 Aug;18(4):215-8. doi: 10.1055/s-2008-1038499. Epub 2008 Aug 14.
LACE is gradually becoming more established for the treatment of constipation. The purpose of this study was to review the current status of LACE procedure in paediatric practice.
A systematic database search was performed. Patients who underwent a LACE procedure between 2002 and May 2007 were reviewed retrospectively. The data was analysed with respect to indications for operation, operative techniques, outcome, and complications. The outcomes were compared with those of right-sided antegrade colonic enema (RACE) procedures, published in the same period.
Nine studies describing 93 patients were identified. The underlying diagnoses were spina bifida (70 %), anorectal malformation (10 %), idiopathic constipation (10 %), Hirschsprung's disease (4 %) and other (6 %). The mean age at operation was 10 years. The various operative procedures used included retubularisation of the sigmoid colon (31 %), retubularisation of the splenic flexure (28 %), left Monti from the descending colon (15 %), and retubularisation of the ileum (3 %). Minimally invasive techniques were used in 23 % of cases. Mean volume of enema used was 414 ml. The mean transit time for enema was 31 minutes. Social continence was achieved in 94 % (complete in 72 %; partial in 22 %) cases. Stomal stenosis was seen in 14 % of cases, of which 9 % required revision of the stoma and 5 % responded to dilatation. Sixteen studies describing 583 patients were found for RACE. Indications for operation were similar to those for LACE. Open procedures were done in 86 % of cases, and laparoscopic assisted procedures in 14 % of cases. Mean age at operation was 10 years. Mean volume of enema used 618 ml. Median evacuation time was 53 minutes. Continence was achieved in 94 % of cases. Stomal stenosis occurred in 26 %.
The results of LACE procedures are encouraging, especially in light of the lower amount of enema fluid required, the quicker enema transit time and fewer complications. Overall outcome (continence) is comparable to that of RACE.
经阑尾腔行顺行结肠灌肠法（LACE）在便秘治疗中的应用正逐渐增多。本研究旨在回顾LACE手术在儿科实践中的现状。
进行系统的数据库检索。对2002年至2007年5月期间接受LACE手术的患者进行回顾性研究。分析手术适应证、手术技术、疗效及并发症等数据。将结果与同期发表的右侧顺行结肠灌肠法（RACE）手术的结果进行比较。
共确定9项研究，涉及93例患者。基础诊断包括脊柱裂（70%）、肛门直肠畸形（10%）、特发性便秘（10%）、先天性巨结肠（4%）及其他（6%）。手术平均年龄为10岁。采用的各种手术方法包括乙状结肠再管化（31%）、脾曲再管化（28%）、降结肠左Monti术（15%）及回肠再管化（3%）。23%的病例采用了微创技术。灌肠平均用量为414毫升。灌肠平均通过时间为31分钟。94%的病例实现了社会控便（72%完全控便；22%部分控便）。14%的病例出现造口狭窄，其中9%需要造口修复，5%经扩张治疗有效。共找到16项描述583例患者的RACE研究。手术适应证与LACE相似。86%的病例采用开放手术，14%的病例采用腹腔镜辅助手术。手术平均年龄为10岁。灌肠平均用量为618毫升。中位排空时间为53分钟。94%的病例实现了控便。26%的病例出现造口狭窄。
LACE手术的结果令人鼓舞，尤其是考虑到所需灌肠液量较少、灌肠通过时间较短且并发症较少。总体疗效（控便）与RACE相当。
