Carnaghan H, Johnson H, Eaton S, de Coppi P, Curry J, Morova M, Cross K, Drake D, Kiely E, Pierro A
UCL Institute of Child Health, Paediatric Surgery Unit, London, UK.
Eur J Pediatr Surg. 2012 Feb;22(1):26-8. doi: 10.1055/s-0031-1285874. Epub 2012 Jan 23.
Stomal stenosis is the commonest complication of the antegrade colonic enema (ACE) procedure, reportedly occurring in 25-55% of patients. As such, a simple ACE stopper device (a small silicone plug sited in the ACE conduit between catheterisations) was designed to prevent stenosis. We performed a long-term follow-up study to determine the effectiveness of the stopper device.
A retrospective case note review was performed of all patients who successfully underwent a primary ACE procedure over an 8.5-year period (January 2002 to June 2010). The inclusion criteria were (i) a minimum of 6 months follow-up, (ii) simple appendicostomy, (iii) caecal/colonic flap. In all patients an ACE stopper was sited in the conduit for at least 4 months and removed only for catheterisation. Data are mean±SEM.
38 children were included in our study. Mean age at surgery was 9.6±0.5 years. Surgery was performed in 22 patients for incontinence and in 16 for chronic constipation. 31 underwent an appendicostomy and 7 had a caecal/colonic flap; all received an ACE stopper. The mean follow-up was 2.6±0.3 years. Only 3 patients (8%) developed stomal stenosis. The first occurred 6 months postoperatively, resulting from an ACE stopper which was too small and consequently persistently fell out. This conduit required dilatation. The second occurred at 27 months secondary to a stomal infection and required surgical revision. The third occurred 8 months postoperatively for no obvious cause, and was treated with dilation. 1 patient experienced stomal leakage.
The ACE stopper is a simple yet highly effective method of preventing stomal stenosis. We recommend using the stopper in all ACE patients.
造口狭窄是顺行结肠灌肠（ACE）手术最常见的并发症，据报道发生率为25%-55%。因此，设计了一种简单的ACE塞子装置（在两次插管之间置于ACE导管内的一个小硅胶塞）来预防狭窄。我们进行了一项长期随访研究以确定该塞子装置的有效性。
对在8.5年期间（2002年1月至2010年6月）成功接受初次ACE手术的所有患者进行回顾性病例记录审查。纳入标准为：（i）至少随访6个月；（ii）单纯阑尾造口术；（iii）盲肠/结肠瓣。在所有患者中，ACE塞子置于导管内至少4个月，仅在插管时取出。数据为平均值±标准误。
我们的研究纳入了38名儿童。手术时的平均年龄为9.6±0.5岁。22例患者因大小便失禁接受手术，16例因慢性便秘接受手术。31例行阑尾造口术，7例有盲肠/结肠瓣；所有患者均使用了ACE塞子。平均随访时间为2.6±0.3年。只有3例患者（8%）发生造口狭窄。第一例发生在术后6个月，原因是ACE塞子太小，因此持续脱落。该导管需要扩张。第二例发生在术后27个月，继发于造口感染，需要手术修复。第三例发生在术后8个月，无明显原因，经扩张治疗。1例患者发生造口渗漏。
ACE塞子是一种简单但非常有效的预防造口狭窄的方法。我们建议在所有ACE患者中使用该塞子。
