Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Boston, Massachusetts 02155, USA.
J Pediatr Gastroenterol Nutr. 2011 May;52(5):574-80. doi: 10.1097/MPG.0b013e3181ff6042.
Antegrade continence enema (ACE) has become an important therapeutic modality in the treatment of intractable constipation and fecal incontinence. There are little data available on the long-term performance of the ACE procedure in children.
A retrospective review of patients who underwent the ACE procedure was conducted. Irrigation characteristics and complications were noted. Outcome was assessed for individual encounters based on frequency of bowel movements, incontinence, pain, and predictability.
One hundred seventeen patients underwent an ACE. One hundred five patients had at least 6 months of follow-up, and were included in the analysis. Diagnoses included myelodysplasia (39%), functional intractable constipation (26%), anorectal malformations (21%), nonrelaxing internal anal sphincter (7%), cerebral palsy (3%), and other diagnoses (4%). The average follow-up was 68 months (range 7-178 months). At the last follow-up, 69% of patients had successful bowel management. Of the 31% of patients who did not have successful bowel management, 20% were using the ACE despite suboptimal results, 10% required surgical removal, and 2% were not using the ACE because of behavioral opposition to it. Patients were started on normal saline, but were switched to GoLYTELY (PEG-3350 and electrolyte solution) if there was an inadequate response (61% at final encounter). Additives were needed in 34% of patients. The average irrigation dose was 23 ± 0.7 mL/kg. The average toilet sitting time was 51.7 ± 3.5 minutes, with infusions running for 12.1 ± 1.2 minutes. Stomal complications occurred in 63% (infection, leakage, and stenosis) of patients, 33% required surgical revision and 6% eventually required diverting ostomies.
Long-term use of the ACE gives successful results in 69% of patients, whereas 63% had a stoma-related complication and 33% required surgical revision of the stoma.
顺行性灌肠（ACE）已成为治疗顽固性便秘和粪便失禁的重要治疗方法。关于 ACE 手术在儿童中的长期效果的数据很少。
对接受 ACE 手术的患者进行回顾性分析。记录冲洗特点和并发症。根据排便频率、失禁、疼痛和可预测性，对每次就诊的结果进行评估。
117 例患者接受 ACE 治疗。105 例患者至少随访 6 个月，纳入分析。诊断包括脊髓发育不良（39%）、功能性难治性便秘（26%）、肛门直肠畸形（21%）、非松弛性内括约肌（7%）、脑瘫（3%）和其他诊断（4%）。平均随访时间为 68 个月（7-178 个月）。最后一次随访时，69%的患者排便管理成功。在 31%的排便管理不成功的患者中，20%的患者尽管结果不理想仍在使用 ACE，10%的患者需要手术切除，2%的患者因对 ACE 行为上的反对而未使用 ACE。患者开始使用生理盐水，但如果反应不足（最后一次就诊时 61%）则改用 GoLYTELY（PEG-3350 和电解质溶液）。34%的患者需要添加物。平均冲洗剂量为 23 ± 0.7 mL/kg。平均坐便时间为 51.7 ± 3.5 分钟，输注时间为 12.1 ± 1.2 分钟。63%（感染、渗漏和狭窄）的患者出现造口并发症，33%需要手术修正，6%最终需要改道造口。
长期使用 ACE 可使 69%的患者获得成功的结果，而 63%的患者出现造口相关并发症，33%的患者需要对造口进行手术修正。
