Teichman J M, Harris J M, Currie D M, Barber D B
Department of Rehabilitation Medicine, University of Texas Health Science Center, Audie L. Murphy Veterans' Affairs Medical Center, San Antonio, USA.
J Urol. 1998 Oct;160(4):1278-81.
We describe the outcomes of adults with neurogenic bowel disease who underwent a Malone antegrade continence enema procedure with or without concomitant urinary diversion.
Consecutive adult patients with neurogenic bowel disease who underwent an antegrade continence enema procedure (continent catheterizable appendicocecostomy for fecal impaction) were retrospectively reviewed.
Of the 7 patients who underwent an antegrade continence enema synchronous urinary procedure (ileal conduit, augmentation ileocystoplasty with continent catheterizable abdominal stoma or augmentation ileocystoplasty) was also performed in 6. Mean patient age was 32 years and mean followup was 11 months. Of the 7 patients 6 who self-administered antegrade continence enemas regularly were continent of stool per rectum and appendicocecostomy, using the appendicocecostomy as the portal for antegrade enemas. All 6 compliant patients reported decreased toileting time and improved quality of life. Preoperative autonomic dysreflexia resolved postoperatively in 3 patients. All urinary tracts were stable. In 4 patients 5 complications occurred, including antegrade continence enema stomal stenosis requiring appendicocutaneous revision (1), antegrade continence enema stomal stenosis requiring dilation (1), superficial wound infection (1), small bowel obstruction requiring lysis of adhesions (1) and urinary incontinence (1 who underwent continent urinary diversion).
Patients with neurogenic bladder and bowel disease may benefit from antegrade continence enema performed synchronously with a urinary procedure. Antegrade continence enema may be indicated alone for neurogenic bowel. Patient selection is important.
我们描述了患有神经源性肠病的成年人接受马龙顺行性节制灌肠术（伴或不伴同期尿路改道）的结果。
对连续接受顺行性节制灌肠术（用于治疗粪便嵌塞的可控性阑尾盲肠造口术）的成年神经源性肠病患者进行回顾性研究。
7例接受顺行性节制灌肠同期尿路手术（回肠导管术、带可控性腹部造口的回肠膀胱扩大术或回肠膀胱扩大术）的患者中，6例还进行了尿路手术。患者平均年龄32岁，平均随访11个月。7例患者中，6例定期自行进行顺行性节制灌肠，直肠和阑尾盲肠造口处无粪便失禁，将阑尾盲肠造口用作顺行灌肠的入口。所有6例依从性好的患者均报告排便时间减少，生活质量改善。3例患者术前的自主神经反射异常术后得到缓解。所有尿路情况稳定。4例患者发生了5例并发症，包括需要阑尾皮肤修复的顺行性节制灌肠造口狭窄（1例）、需要扩张的顺行性节制灌肠造口狭窄（1例）、浅表伤口感染（1例）、需要粘连松解的小肠梗阻（1例）和尿失禁（1例接受了可控性尿流改道）。
患有神经源性膀胱和肠病的患者可能受益于与尿路手术同期进行的顺行性节制灌肠术。顺行性节制灌肠术单独用于神经源性肠病可能是合适的。患者选择很重要。
