Sturkenboom R, van der Wilt A A, van Kuijk S M J, Ahmad A, Janssen P T, Stassen L P S, Melenhorst J, Breukink S O
Department of Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands.
Int J Colorectal Dis. 2018 Oct;33(10):1341-1348. doi: 10.1007/s00384-018-3088-5. Epub 2018 Jun 22.
The aim of the study was to assess the long-term outcome of a Malone antegrade continence enema (MACE) procedure for fecal incontinence or constipation in adults.
This retrospective single-center study assessed the long-term outcome and quality of life (QoL) of patients who underwent a MACE procedure between 2005 and 2014 at the Maastricht University Medical Centre. Success rate was quantified by using Malone's continence scale. Quality of life was assessed by validated questionnaires covering general quality of life (SF-36 and Karnofsky scale), current pain level (visual analog scale), fecal incontinence (Vaizey incontinence survey), or constipation (Cleveland Clinic Constipation Score).
Based on patients' records, 22 out of 30 patients (73%; 95% CI 54-87%) were still using their MACE. Mean follow-up was 43 months (SD 25.9) since time of surgery. According to the Malone continence scale, the overall success rate was 37% (95% CI 20.0-53.3). Nine patients developed a postoperative complication. Eighteen out of 22 patients (13 with constipation and 5 with fecal incontinence) returned the QoL questionnaires (82% response rate). Long-term quality of life of patients with a MACE did not differ from the general Dutch population.
In our cohort of patients with fecal incontinence or constipation, MACE resulted in a disappointed overall success rate of 37%. However, it may be indicated in patients who do not prefer more invasive surgical procedures or a definite stoma. The success and morbidity rate should be thoroughly discussed with the patients preoperatively.
本研究旨在评估马龙顺行性节制灌肠术（MACE）治疗成人大便失禁或便秘的长期疗效。
这项回顾性单中心研究评估了2005年至2014年间在马斯特里赫特大学医学中心接受MACE手术患者的长期疗效和生活质量（QoL）。采用马龙节制量表对成功率进行量化。通过经验证的问卷评估生活质量，问卷涵盖总体生活质量（SF-36和卡诺夫斯基量表）、当前疼痛程度（视觉模拟量表）、大便失禁（韦齐大便失禁调查）或便秘（克利夫兰诊所便秘评分）。
根据患者记录，30例患者中有22例（73%；95%可信区间54 - 87%）仍在使用其MACE。自手术时间起平均随访43个月（标准差25.9）。根据马龙节制量表，总体成功率为37%（95%可信区间20.0 - 53.3）。9例患者出现术后并发症。22例患者中有18例（13例便秘患者和5例大便失禁患者）返回了生活质量问卷（回复率82%）。接受MACE手术患者的长期生活质量与荷兰普通人群无差异。
在我们的大便失禁或便秘患者队列中，MACE的总体成功率令人失望，为37%。然而，对于不倾向于更具侵入性手术或确定性造口的患者可能适用。术前应与患者充分讨论成功率和发病率。
