University of Michigan, Ann Arbor, Michigan.
J Urol. 2013 Oct;190(4 Suppl):1529-33. doi: 10.1016/j.juro.2013.01.092. Epub 2013 Feb 1.
The Malone antegrade continence enema is used for refractory fecal dysfunction in the pediatric neuropathic population. While various locations along the colon have been described, the optimal site for achieving efficient enemas remains unknown. We reviewed our experience with the Malone antegrade continence enema procedure and investigated functional outcomes and complications associated with proximal and distal locations.
We performed an institutional review board approved, retrospective chart review of 109 consecutive MACE procedures done by a single surgeon from 2000 to 2012. Preoperative patient characteristics, intraoperative techniques and postoperative outcomes were reviewed and statistical analysis was performed.
Included in analysis were 90 patients treated with a total of 109 MACE procedures. Average age at operation was 13.8 years. Myelomeningocele was the most common diagnosis. Most patients underwent simultaneous urinary reconstruction. Stomal complications were most common (49% of patients). We compared the outcomes of proximal (cecal) MACE in 48 cases and distal (sigmoid colon) MACE in 55. Location did not affect the overall efficiency of fecal continence. Flush time was shorter for distal than for proximal MACE stomas (37.2 vs 61.2 minutes, p <0.001). Of the patients 15 underwent a total of 20 complete MACE revisions, including 12 proximal and 6 distal MACEs. As a channel, appendix was associated with a higher but not statistically significant stomal complication rate compared to colon (42% vs 25%).
A cecal, transverse or colonic location for MACE results in acceptable outcomes. Distal MACE is associated with significantly shorter flush time and possibly fewer stomal complications. Stomal complications remain a frustrating reality of the MACE procedure.
Malone 经肛顺行灌肠术用于治疗小儿神经性排便功能障碍。虽然结肠的各个部位都有描述，但实现高效灌肠的最佳部位仍不清楚。我们回顾了我们在 Malone 经肛顺行灌肠术方面的经验，并研究了近端和远端位置与功能结果和并发症的关系。
我们对 2000 年至 2012 年间由一位外科医生进行的 109 例连续 MACE 手术进行了机构审查委员会批准的回顾性图表审查。回顾了术前患者特征、术中技术和术后结果，并进行了统计学分析。
纳入分析的有 90 例患者，共进行了 109 例 MACE 手术。手术时平均年龄为 13.8 岁。最常见的诊断是脊髓脊膜膨出。大多数患者同时进行了尿流重建。造口并发症最常见（49%的患者）。我们比较了近端（盲肠）MACE 组 48 例和远端（乙状结肠）MACE 组 55 例的结果。位置不影响粪便控便的总体效率。远端 MACE 的冲洗时间比近端 MACE 短（37.2 分钟比 61.2 分钟，p <0.001）。15 例患者共进行了 20 例 MACE 完全翻修，包括 12 例近端和 6 例远端 MACE。作为一种通道，阑尾与结肠相比，造口并发症发生率较高，但无统计学意义（42%比 25%）。
MACE 的盲肠、横结肠或结肠位置可获得可接受的结果。远端 MACE 冲洗时间更短，可能造口并发症更少。造口并发症仍然是 MACE 手术的一个令人沮丧的现实。
