Hensle T W, Reiley E A, Chang D T
Department of Urology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
J Am Coll Surg. 1998 Jun;186(6):669-74. doi: 10.1016/s1072-7515(98)00091-x.
In patients with spina bifida, traditional bowel management programs such as suppositories, retrograde enemas, and manual disimpaction have been largely unsatisfactory. The Malone antegrade continence enema (ACE) procedure has largely changed our approach to bowel management in this patient group.
Over a 3-year period between January 1994 and January 1997, 27 patients with spina bifida underwent the Malone ACE procedure at our institutions. At the time of their ACE procedure, four patients underwent simultaneous continent urinary diversion and three had simultaneous small-bowel bladder augmentation. All the patients were evaluated for 9 months or more after their procedure, and 10 of the patients have been followed for more than 2 years.
Postoperatively, predictable bowel control and continence were achieved in 19 of the 27 patients, but 6 had some rectal soiling requiring a sanitary pad. All patients were out of diapers and none reported stomal leakage. Eighteen of the 27 patients were able to manage independently and 9 required assistance. Two patients had stopped using their ACE stoma despite good technical results. The appendix was used as a catheterizable stoma in 15 of the 27 patients. The appendix was not available in 12 patients, so a tubularized cecal flap was used in 9 and a small-bowel neoappendix was created in 3. Complications included stomal stenosis in 5 patients, cecal-flap necrosis in 1, and stomal granulations in 3.
We believe that the ACE procedure provides reliable colonic emptying and avoids fecal soiling in the majority of individuals, and we find it widely and enthusiastically accepted by patients with spina bifida.
对于脊柱裂患者，传统的肠道管理方案，如栓剂、逆行灌肠和手法清除粪便嵌塞，大多不尽人意。马龙顺行可控灌肠（ACE）手术在很大程度上改变了我们对该患者群体肠道管理的方法。
在1994年1月至1997年1月的3年期间，27例脊柱裂患者在我们机构接受了马龙ACE手术。在进行ACE手术时，4例患者同时进行了可控性尿流改道，3例同时进行了小肠膀胱扩大术。所有患者在手术后均接受了9个月或更长时间的评估，其中10例患者随访时间超过2年。
术后，27例患者中有19例实现了可预测的肠道控制和大便失禁，但6例有一些直肠污染，需要使用卫生护垫。所有患者均不再使用尿布，且无人报告造口渗漏。27例患者中有18例能够独立管理，9例需要协助。尽管技术效果良好，但有2例患者已停止使用ACE造口。27例患者中有15例使用阑尾作为可插管造口。12例患者无法使用阑尾，因此9例使用了管状盲肠瓣，3例制作了小肠新阑尾。并发症包括5例造口狭窄、1例盲肠瓣坏死和3例造口肉芽组织增生。
我们认为，ACE手术可提供可靠的结肠排空，并避免大多数患者出现粪便污染，我们发现它被脊柱裂患者广泛且热情地接受。
