Chong Clara, Featherstone Neil, Sharif Shazia, Cherian Abraham, Cuckow Peter, Mushtaq Imran, De Coppi Paolo, Cross Kate, Curry Joseph
Department of Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
Department of Paediatric Urology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, UK.
Pediatr Surg Int. 2016 Apr;32(4):397-401. doi: 10.1007/s00383-016-3857-6. Epub 2016 Jan 29.
Antegrade continence enema (ACE) revolutionised the lives of children with chronic constipation and soiling. Parents often ask how long the ACE will be required. We looked at our patients 5 years after ACE formation to answer the question.
We reviewed clinical notes of all patients undergoing ACE procedure during January 1990 to December 2010. Only patients with >5 years follow-up were included. Data are given as median (range).
133 patients were included with >5 years of follow-up. Primary pathology was anorectal anomaly (ARA) 64 (48%); spinal dysraphism (SD) 40 (30%); functional constipation (FC) 14 (10%); Hirschsprung's Disease (HD) 10 (8%) and others 5 (4%). Median follow-up was 7 years (5-17 years). Overall 74% still use their ACE; whilst 26% no longer access their stoma, of whom 47% recovered normal colonic function. 50% of HD patient recover colonic function. FC has the highest failure rate at 21%.
Overall 86% achieved excellent clinical outcome with 74% of patient still using their ACE at 5 years. HD has the highest recovery rate of 50%. FC has a more unreliable clinical outcome with 21% recovered colonic function and 21% failed. Outcome varied dependent on the background diagnosis.
顺行性节制灌肠术（ACE）彻底改变了慢性便秘和大便失禁儿童的生活。家长们常常会问需要进行ACE治疗多长时间。我们对接受ACE治疗5年后的患者进行了观察，以回答这个问题。
我们回顾了1990年1月至2010年12月期间所有接受ACE手术患者的临床记录。仅纳入随访时间超过5年的患者。数据以中位数（范围）表示。
133例患者纳入研究，随访时间超过5年。主要病因包括肛门直肠畸形（ARA）64例（48%）；脊柱裂（SD）40例（30%）；功能性便秘（FC）14例（10%）；先天性巨结肠（HD）10例（8%），其他5例（4%）。中位随访时间为7年（5 - 17年）。总体而言，74%的患者仍在使用ACE；26%的患者不再使用造口，其中47%恢复了正常结肠功能。HD患者中有50%恢复了结肠功能。FC的失败率最高，为21%。
总体而言，86%的患者取得了良好的临床效果，74%的患者在5年后仍在使用ACE。HD的恢复率最高，为50%。FC的临床效果更不可靠，21%的患者恢复了结肠功能，21%的患者治疗失败。治疗结果因基础诊断不同而有所差异。
