CAJ | 학술논문

目的 Malone顺行灌肠(MACE)是一种对机体损伤较小的手术方式,通过问卷调查的形式来评估其在顽固性大便失禁治疗的临床疗效.方法以2000年1月至2009年12月期间接受MACE治疗的32例患儿为研究对象,临床观察和随访时间平均约3.4年,结合李正和Shell的评价项目内容并根据临床实际情况,设计了一张问卷调查,其内容主要包括手术方式、应用情况、术后并发症和临床满意度等方面,通过该问卷综合评价MACE在治疗顽固性大便失禁中的作用.结果 32例手术患儿中30例获得随访,患儿总体满意率为83.3％,术后患儿均能独立完成灌肠操作,手术方式和造瘘口部位选择在引起并发症方面进行比较,差异无明显统计学意义(P＞0.05),83.3％患儿术后插管顺利,57％的患儿坚持每日清晨灌肠一次和28％的患儿每日需灌肠两次可以保持肛门清洁.4例患儿术后有时仍有肛周污粪,造瘘口狭窄、瘘口反流、瘘口周围皮炎、腹胀、腹痛等是术后遇到的并发症,但这些并发症发生率较低,经过进一步治疗后可好转.结论 MACE具有疗效显著、手术创伤小和副作用少等方面的优点,是治疗顽同性大便失禁的良好方法.
목적 Malone순행관장(MACE)시일충대궤체손상교소적수술방식,통과문권조사적형식래평고기재완고성대편실금치료적림상료효.방법 이2000년1월지2009년12월기간접수MACE치료적32례환인위연구대상,림상관찰화수방시간평균약3.4년,결합리정화Shell적평개항목내용병근거림상실제정황,설계료일장문권조사,기내용주요포괄수술방식、응용정황、술후병발증화림상만의도등방면,통과해문권종합평개MACE재치료완고성대편실금중적작용.결과 32례수술환인중30례획득수방,환인총체만의솔위83.3％,술후환인균능독립완성관장조작,수술방식화조루구부위선택재인기병발증방면진행비교,차이무명현통계학의의(P＞0.05),83.3％환인술후삽관순리,57％적환인견지매일청신관장일차화28％적환인매일수관장량차가이보지항문청길.4례환인술후유시잉유항주오분,조루구협착、루구반류、루구주위피염、복창、복통등시술후우도적병발증,단저사병발증발생솔교저,경과진일보치료후가호전.결론 MACE구유료효현저、수술창상소화부작용소등방면적우점,시치료완동성대편실금적량호방법.
Objective The Malone antegrade colonic enema (MACE) procedure is a minimally invasive therapy for refractory fecal continence.The aim of this study was to assess curative efficacy for patients undergoing MACE via questionnaire investigation.Methods Totally 32 children patients underwent MACE due to fractory fecal continence between 2000 and 2009.The follow-up period was averagely 3.4 years,and all patients filled in the questionnaire form based on scoring system raised by Li-Zheng and Shell.Surgical methods,applications,complications and clinical curative satisfaction as the main content,were involved in questionnaire for evaluation of curative efficacy of MACE.Results 30 patients of all were followed-up after MACE procedure.The clinical satisfaction was 83.3％,and they could administer the enema by themselves.Regarding to the post-operative complications,no significantly statistical difference was seen in procedures with differential techniques and ostomies.57 percent of patients administered the enema once and 28 percent of patients did twice,aiming to keep anal clearance.4 patients were complicated with the anal or stoma soiling,stoma stenosis,skin inflammation,abdominal distension or pain.Further treatment made improvement.Conclusions MACE procedure is a reliable,minimally invasive surgery with low morbidity for refractory fecal continence.