小儿粪便失禁的新阑尾造口术治疗。

Neoappendicostomy in the management of pediatric fecal incontinence.

机构信息

Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.

出版信息

J Pediatr Surg. 2011 Jun;46(6):1243-9. doi: 10.1016/j.jpedsurg.2011.03.059.

DOI:10.1016/j.jpedsurg.2011.03.059

PMID:21683230

Abstract

PURPOSE

The Malone appendicostomy, for antegrade enemas, has improved the quality of life for many children with fecal incontinence. In patients whose appendix has been removed, a neo-appendix can be created. We describe our approach and experience with this procedure as an option for surgeons managing children with fecal incontinence.

METHODS

The procedure involves creating a transverse flap of cecum that receives its blood supply by a transverse mesenteric branch. This flap is then tubularized around a feeding tube. The surrounding colon is plicated around the neo-appendix to prevent leakage of stool. The tip of the flap is then anastomosed to the deepest portion of the umbilicus. We reviewed our experience with this procedure, including results and complications. IRB approval was obtained.

RESULTS

Eighty patients required a neo-appendicostomy. Sixty-six patients (82%) had an anorectal malformation, four had spina bifida, and ten had other diagnoses. The reasons for not having an appendix available included: "incidental" appendectomy (34, 42.5%), use of the appendix for a Mitrofanoff procedure (20, 25%), and Ladd's procedure (5, 6%). In fifteen patients (19%) we could find no appendix and assume that it was removed previously. Following neoappendicostomy, nine patients (11%) developed a stricture, and seven patients had leakage (9%). In 2004, we modified the appendiceal-umbilical anastomosis and among these patients, only one patient (3%) developed a stricture, compared with eight patients (18%) without the modification. All seven patients with leakage were within the first forty cases. No patient in the last forty cases had a leakage.

CONCLUSIONS

In patients with the potential for fecal incontinence, the appendix should be preserved. In patients without an appendix, the neo-appendicostomy is a valuable tool for fecally incontinent patients. We have found that the V-V anastomosis had a reduced rate of stricture, and the rate of leakage seems to be related to surgical experience.

摘要

目的

经麦氏阑尾造口术（Malone appendicostomy）行顺行灌肠，可提高许多大便失禁儿童的生活质量。对于已切除阑尾的患者，可以创建新的阑尾。我们介绍了我们采用这种手术方式来治疗大便失禁患儿的经验。

方法

该手术包括创建一个横结肠瓣，其血供来自横结肠系膜分支。然后将该瓣围绕喂养管进行管状化。将新的阑尾周围的结肠进行折叠，以防止粪便泄漏。然后将瓣的尖端吻合到脐的最深部。我们回顾了该手术的经验，包括结果和并发症。获得了机构审查委员会的批准。

结果

80 例患者需要进行新的阑尾造口术。66 例患者（82%）存在肛门直肠畸形，4 例存在脊膜膨出，10 例存在其他诊断。没有阑尾的原因包括：“偶然”阑尾切除术（34 例，42.5%）、阑尾用于米托凡诺夫手术（20 例，25%）和拉达手术（5 例，6%）。在 15 例患者（19%）中，我们无法找到阑尾，推测之前已切除。新的阑尾造口术后，9 例（11%）发生狭窄，7 例发生渗漏（9%）。2004 年，我们修改了阑尾-脐吻合术，在这些患者中，只有 1 例（3%）发生狭窄，而没有进行修改的 8 例患者中（18%）有 8 例发生狭窄。所有 7 例渗漏均发生在最初的 40 例中。在最后 40 例中，没有发生渗漏。