腹腔镜技术在Malone可控性顺行灌肠术中的应用效果

Laparoscopic Malone antegrade continence enema

目的 评价腹腔镜辅助阑尾原位造口行Malone可控性顺行灌肠(Malone antegrade continence enema,MACE)的临床效果.方法 回顾性分析2015年3月至2017年7月间山西省儿童医院诊治的肛门成形术后大便失禁患儿25例,其中14例行腹腔镜辅助MACE术,11例行开腹手术.结果 腹腔镜组的手术时间比开腹组缩短[(38.3±2.5) min比(60.5±3.6) min,t=13.71,P=0.00].术后随访6个月~3年,两组患儿无1例出现肠梗阻,阑尾造口处无粪便溢出,无污粪和便失禁.腹腔镜组发生1例瘘口狭窄,2例有黏膜外翻;开腹组发生2例瘘口狭窄,1例出现黏膜外翻.与术前比较,腹腔镜组手术前后便秘和便失禁严重程度评分为33.7±1.5、12.1±1.4,t=28.4,P=0.00;开腹组为33.3±1.7、12.5±1.6,t=25.4,P=0.00.腹腔镜组和开腹组术后灌注量分别为(607±151)、(594±161)ml,t=0.17,P=0.87;MACE评分分别为22.1±1.4、22.0±1.7,t =0.18,P =0.86;便秘和便失禁程度评分分别为12.1±1.4、12.5±1.6,t=0.46,P=0.65,两组相比差异均无统计学意义.结论 应用腹腔镜Malone手术操作简单,创伤小,治疗效果满意.

Objective To evaluate laparoscopic appendicostomy in Malone antegrade continence enema (MACE). Methods 25 children with fecal incontinence undergoing MACE were divided into by laparoscopic technique (14 cases) and by laparotomy (11 patients). Results The operation time [(38.3±2.5) min vs.(60.5±3.6) min,t=13.7,P=0.00] was shorter in the laparoscopy group.All patients were followed up for 6 months to 3 years.No intestinal obstruction,fecal leakage in stoma and anal fecal incontinence or soiling happened.In laparoscopy group,the stomal stricture developed in 1 patient.The mucosa prolapse developed in 2 patients.In the laparotomy group,the stomal stricture developed in 2 patients.The mucosa prolapse in 1 patient.The symptom severity scoring for constipation and fecal incontinence after operation decreased in the laparoscopy group (12.1±1.4 vs.33.7±1.5,t=28.4,P=0.00) .laparotomy group (12.5±1.6 vs.33.3±1.7,t=25.36,P=0.00).While the irrigation volume [(607±151) ml vs.(594±161) ml,t=0.17,P=0.87],MACE scoring (22.1±1.4 vs.22.0±1.7,t=0.18,P=0.86) and symptom severity scoring for constipation and fecal incontinence (12.1±1.4 vs.12.5±1.6,t=0.46,P=0.65) were not statistically different. Conclusions The laparoscopic technique can make the MACE easier to operate and less traumatic.