Division of Pediatric Surgery, Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
J Pediatr Surg. 2013 Oct;48(10):2128-33. doi: 10.1016/j.jpedsurg.2013.04.009.
Intractable incontinence affects a large number of children and young adults in the US. The goal of this study is to evaluate the long-term outcomes of surgical access for administration of antegrade continence enemas (ACE) in affected children and young adults.
Patients who underwent surgical procedure to enable administration of ACE from 1994 to 2011 were retrospectively reviewed. Data collected included patient demographics, primary diagnosis, surgical technique, conduit used, complications, follow-up duration, and social continence.
Sixty eighty patients underwent surgery to enable ACE; mean follow up was 61 months. Enteral conduit (EC) was performed in 19 patients, tube cecostomy catheters (CC) in 49. Meningomyelocele was diagnosed in 60% of patients. Mean age was 11 (1.67-53) years. Complications included tube dislodgement (43%), granulation tissue (46%), site infection (13%), leakage (32%), break in the tube (6%) and tract stenosis (6%). Complete social continence was achieved in 68%, partial continence was achieved in 29%, and no benefit was achieved in 3% of patients. The rate of complications and incontinence resolution following CC was 78% and 66%, and following EC 89% and 74%. The differences were not statistically significant. CC patients developed granulation tissue more frequently (53%) and leaks of fecal material less frequently (20%) compared to EC patients (26% and 53%) (p < 0.05 and < 0.01). Although children 7 years or younger developed more overall complications (94%) than older patients (69%; p < 0.05), there was not a significant difference in the frequency of any one complication or in the rate of continence, between the two groups. Multivariate analysis showed that EC is three times more likely to be complicated by fecal leakage. CC patients are at greater risk to develop granulation tissue (p < 0.05).
Most patients achieved social continence and improved hygiene with the aid of ACE. Younger children also benefited greatly from institution of ACE. CC was associated with fewer major complications such as leak of fecal contents than EC but required regular tube changes.
美国有大量儿童和青年深受顽固型失禁之苦。本研究旨在评估对受影响的儿童和青年施行顺行灌洗造口术（ACE）的长期效果。
回顾性分析了 1994 年至 2011 年间接受手术以实施 ACE 的患者。收集的数据包括患者的人口统计学特征、主要诊断、手术技术、使用的导管、并发症、随访时间以及社会控便情况。
共有 680 例患者接受了 ACE 手术；平均随访时间为 61 个月。肠造口术 19 例，经皮乙状结肠造口术 49 例。60%的患者被诊断为脑脊膜膨出。患者平均年龄为 11（1.67-53）岁。并发症包括导管移位（43%）、肉芽组织（46%）、局部感染（13%）、渗漏（32%）、导管破裂（6%）和窦道狭窄（6%）。68%的患者完全控便，29%部分控便，3%的患者无获益。经皮乙状结肠造口术的并发症发生率和失禁缓解率分别为 78%和 66%，肠造口术分别为 89%和 74%，两者差异无统计学意义。与肠造口术患者相比，经皮乙状结肠造口术患者更常发生肉芽组织（53%）和较少发生粪便渗漏（20%）（p<0.05 和<0.01）。尽管 7 岁及以下儿童的总并发症发生率（94%）高于年龄较大的儿童（69%）（p<0.05），但两组之间任何一种并发症的发生率或控便率差异均无统计学意义。多因素分析显示，肠造口术发生粪便渗漏的风险是经皮乙状结肠造口术的三倍。经皮乙状结肠造口术患者发生肉芽组织的风险更大（p<0.05）。
大多数患者通过 ACE 获得了社会控便和改善了卫生状况。年幼的儿童也从 ACE 的实施中获益匪浅。与肠造口术相比，经皮乙状结肠造口术发生如粪便渗漏等主要并发症的风险较低，但需要定期更换导管。
