Neurourology Service, Unipolar Spinal Unit, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
Unit of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy.
Spinal Cord Ser Cases. 2021 Apr 23;7(1):34. doi: 10.1038/s41394-021-00397-3.
Patients with severe neurogenic bowel dysfunction (NBD) may undergo the Malone antegrade continence enema (MACE) surgery to perform antegrade bowel irrigation (ABI). The standard approach may be prevented by a previous appendectomy or complicated by appendicular stenoses and/or stomal leakages. We present the experience by our tertiary referral center for NBD, adopting a modified surgical technique, based on a neoappendix with the terminal ileum to preserve the natural anti-reflux mechanism of the ileocecal valve and avoid stool leakage, and a largely available transanal irrigation (TAI) system to catheterize the neoappendix and perform ABI.
Three individuals with NBD successfully underwent our modified MACE program. Case 1 had cauda equina syndrome. He underwent surgery at 40. Case 2 was a man who suffered from spinal cord dysfunction due to acute disseminated encephalomyelitis, functionally T12 AIS B, at 57. Case 3 was a man with traumatic L1 AIS B paraplegia. At 60 he underwent surgery after 29 years since the injury. He needed a surgical revision due to a postoperative subcutaneous infection. After 121, 84 and 14 months from surgery, the three individuals performed ABI every 2 days, presented functional stomas, had no fecal incontinence, and reported an NBD score of 6, compared to 40, 33 and 35 pre-operatively.
To our knowledge, this is the first report of MACE combining a tapered terminal ileum conduit and an adapted TAI system. Our approach proved to be a safe and effective strategy for severe NBD avoiding a colostomy.
患有严重神经源性肠功能障碍（NBD）的患者可能需要接受 Malone 顺行控肠灌洗（MACE）手术以进行顺行肠灌洗（ABI）。先前的阑尾切除术可能会阻碍标准方法的实施，或者阑尾狭窄和/或造口漏等并发症可能会使该方法复杂化。我们所在的 NBD 三级转诊中心介绍了一种改良的手术技术，该技术基于末端回肠的新阑尾，以保留回盲瓣的天然抗反流机制并避免粪便渗漏，并采用广泛可用的经肛灌洗（TAI）系统来对新阑尾进行置管和执行 ABI。
3 名 NBD 患者成功接受了我们改良的 MACE 方案。病例 1 患有马尾综合征，他在 40 岁时接受了手术。病例 2 是一名男子，因急性播散性脑脊髓炎导致脊髓功能障碍，功能 T12 AIS B，57 岁时接受了手术。病例 3 是一名男子，因外伤性 L1 AIS B 截瘫，在受伤后 29 年 60 岁时接受了手术。由于术后皮下感染，他需要进行手术修正。术后 121、84 和 14 个月，这 3 名患者每两天进行一次 ABI，造口功能正常，没有粪便失禁，并报告 NBD 评分分别为 6，而术前分别为 40、33 和 35。
据我们所知，这是首例将锥形末端回肠导管与改良 TAI 系统相结合的 MACE 报告。我们的方法被证明是一种安全有效的治疗严重 NBD 的策略，可以避免结肠造口术。
