Ellsworth P I, Webb H W, Crump J M, Barraza M A, Stevens P S, Mesrobian H G
Division of Urology, University of Florida, Jacksonville, Florida, USA.
J Urol. 1996 Apr;155(4):1416-8.
Functional alterations of the gastrointestinal and genitourinary tracts, and physical limitations in children with spina bifida, imperforate anus and spinal cord injury challenge the ability to have independent fecal and urinary continence. Urologists have successfully helped these patients achieve urinary continence. We report our experience with the antegrade colonic enema procedure, which allows select individuals to achieve continence of stool, enhancing quality of life.
Since December 1992, 18 antegrade colonic enema procedures were performed in 12 female and 6 male patients 5 to 31 years old of whom 14 had spina bifida, 2 had imperforate anus and 2 had spinal cord injury. Simultaneous urological continence procedures were performed in 8 patients, including appendicovesicostomy in 4, augmentation cystoplasty in 2 and augmentation cystoplasty plus an ileal Mitrofanoff procedure in 2. Four patients previously underwent urological reconstruction.
In 24 months of followup (average 6.6) all patients with a functioning stoma remained continent of stool and 17 were continent of urine. Complications related to the antegrade colonic enema procedure occurred in 4 children (22%) of whom 3 required further surgery. Three patients (17%) had minor stomal stenosis.
The antegrade colonic enema procedure is easily performed and it should be considered for any child with significant physical limitations and/or refractory fecal incontinence before urological continence promoting procedures are done.
脊柱裂、肛门闭锁和脊髓损伤患儿的胃肠道和泌尿生殖道功能改变以及身体限制对实现自主排便和排尿能力构成挑战。泌尿科医生已成功帮助这些患者实现了排尿自控。我们报告了我们在顺行结肠灌肠术方面的经验，该手术使部分患者能够实现大便自控，提高了生活质量。
自1992年12月以来，对12名女性和6名男性患者进行了18例顺行结肠灌肠术，患者年龄在5至31岁之间，其中14例患有脊柱裂，2例患有肛门闭锁，2例患有脊髓损伤。8例患者同时进行了泌尿自控手术，包括4例阑尾膀胱造口术、2例膀胱扩大术和2例膀胱扩大术加回肠Mitrofanoff手术。4例患者先前接受过泌尿外科重建手术。
在24个月的随访期（平均6.6个月）内，所有造口功能正常的患者均保持大便自控，17例保持小便自控。4名儿童（22%）出现了与顺行结肠灌肠术相关的并发症，其中3例需要进一步手术。3例患者（17%）有轻度造口狭窄。
顺行结肠灌肠术操作简便，在进行促进泌尿自控的手术之前，对于任何有明显身体限制和/或难治性大便失禁的儿童都应考虑采用该手术。
