Division of Gastroenterology, Department of Pediatrics, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
Gastrointest Endosc. 2011 Jan;73(1):98-102. doi: 10.1016/j.gie.2010.09.011.
The antegrade continence enema (ACE) procedure has been widely used in the management of children with defecation disorders. The ACE procedure has undergone many technical modifications. We developed a safe and minimally invasive technique, the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC).
To compare LAPEC to laparoscopic cecostomy in terms of operative time, hospital length of stay, and procedure-related morbidity.
Retrospective review of children undergoing the ACE procedure.
Two tertiary-care centers.
This study involved children with defecation disorders.
The ACE procedure.
Procedure complications, length of stay, and operative time.
Fifty patients underwent LAPEC, and 15 underwent laparoscopic cecostomy. Of the LAPEC patients, 70% were male, with mean age 12 ± 4.2 years, mean operative time 100.1 ± 16.6 minutes, and mean length of stay 3.4 ± 1.4 days. Of the laparoscopic cecostomy patients, 56% were male, with mean age 10.5 ± 4 years, mean operative time 100.8 ± 19.1 minutes, and mean length of stay 3.8 ± 1.6 days. There was no statistical difference between the 2 groups. The single intraoperative complication during LAPEC was a cecal hematoma. Postoperative complications after LAPEC included 6 patients with low-grade fever, 3 patients with tube dislodgement (2 treated by repeat LAPEC and the other by open surgery), and 2 patients with skin breakdown. Of the 50 LAPEC patients and their families, 48 were satisfied with the outcome.
Retrospective study.
LAPEC is a safe, minimally invasive procedure for cecostomy placement in children with refractory constipation or fecal incontinence.
顺行性灌肠术（ACE）已广泛应用于儿童排便障碍的治疗。该术式经历了许多技术改进，我们开发了一种安全微创的技术，即腹腔镜辅助经皮内镜乙状结肠造口术（LAPEC）。
比较 LAPEC 与腹腔镜乙状结肠造口术在手术时间、住院时间和与手术相关的发病率方面的差异。
对接受 ACE 治疗的儿童进行回顾性研究。
两家三级医疗中心。
本研究纳入排便障碍的儿童。
ACE 手术。
手术并发症、住院时间和手术时间。
50 例患者接受 LAPEC，15 例接受腹腔镜乙状结肠造口术。LAPEC 组中，70%为男性，平均年龄 12±4.2 岁，平均手术时间 100.1±16.6 分钟，平均住院时间 3.4±1.4 天。腹腔镜乙状结肠造口术组中，56%为男性，平均年龄 10.5±4 岁，平均手术时间 100.8±19.1 分钟，平均住院时间 3.8±1.6 天。两组间无统计学差异。LAPEC 术中唯一的并发症是乙状结肠血肿。LAPEC 术后并发症包括 6 例低热，3 例引流管脱落（2 例经重复 LAPEC 治疗，另 1 例需开放手术），2 例皮肤破损。50 例 LAPEC 患者及其家属中，48 例对结果满意。
回顾性研究。
LAPEC 是一种安全、微创的乙状结肠造口术，适用于难治性便秘或粪便失禁的儿童。
