Kiely E M, Ade-Ajayi N, Wheeler R
Department of Surgery, Hospital for Children, London, UK.
J R Soc Med. 1995 Feb;88(2):103P-104P.
The introduction of the Malone procedure has improved the outlook for children with severe faecal incontinence. Phosphate and saline enemas are administered through the exteriorized appendix in antegrade fashion to achieve evacuation and ensure cleanliness. The appendix functions as a non-refluxing catheterizable channel: If it is not available for use, a tubularized caecal flap is a safe alternative. We have constructed Malone stomas using the appendix in 20 patients and another seven patients have undergone the caecal flap modification. The mean age was 8.6 years. Eleven of the patients were boys and 16 (59%) were girls. Six children required dilatation or revision of their stomas for stenosis. One developed small bowel obstruction and another has stopped using the stoma. The results of the continence enemas were considered to be very good by the vast majority of patients and their carers. Our recent experience suggests that bisacodyl may be a valuable adjunct to the antegrade enemas of phosphate and saline. We believe that this procedure may be extended with benefit to adults with serious faecal incontinence in whom standard measures have failed.
马龙手术的引入改善了严重大便失禁患儿的预后。通过外置的阑尾以顺行方式给予磷酸盐和盐水灌肠，以实现排便并确保清洁。阑尾起到了一个不可反流的可插管通道的作用：如果无法使用阑尾，管状盲肠瓣是一种安全的替代方法。我们已使用阑尾为20例患者构建了马龙造口，另有7例患者接受了盲肠瓣改良术。平均年龄为8.6岁。其中11例患者为男孩，16例（59%）为女孩。6名儿童因狭窄需要对其造口进行扩张或修复。1例发生小肠梗阻，另1例已停止使用造口。绝大多数患者及其护理人员认为节制灌肠的效果非常好。我们最近的经验表明，比沙可啶可能是磷酸盐和盐水顺行灌肠的一种有价值的辅助药物。我们认为，对于标准措施无效的严重大便失禁成人患者，该手术可能会有益地扩展应用。
