[1]李帅 汤绍涛** 史雯嘉 刘源 曹国庆 普佳睿 李康 杨德华 周莹 李时望 王勇 毛永忠.腹腔镜辅助Malone手术治疗儿童完全性大便失禁的初步观察[J].中国微创外科杂志,2019,01(12):1103-1106.
　Li Shuai,Tang Shaotao,Shi Wenjia,et al.Preliminary Results of Laparoscopicassisted Malone Operation for Intractable Fecal Incontinence in Children[J].Chinese Journal of Minimally Invasive Surgery,2019,01(12):1103-1106.
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腹腔镜辅助Malone手术治疗儿童完全性大便失禁的初步观察()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2019年12期
页码:
1103-1106
栏目:
短篇论著
出版日期:
2019-12-25

文章信息/Info

Title:
Preliminary Results of Laparoscopicassisted Malone Operation for Intractable Fecal Incontinence in Children
作者:
李帅 汤绍涛** 史雯嘉 刘源 曹国庆 普佳睿 李康 杨德华 周莹 李时望 王勇 毛永忠
（华中科技大学同济医学院附属协和医院小儿外科，武汉430022）
Author(s):
Li Shuai;  Tang Shaotao;  Shi Wenjia;  et al.
Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
关键词:
大便失禁; 先天性巨结肠; 先天性肛门直肠畸形; 可控性顺行性灌肠; 腹腔镜手术
Keywords:
Fecal incontinence; Hirschsprung’s disease; Anorectal malformation; Antegrade continence enema; Laparoscopy
文献标志码:
A
摘要:
目的探讨腹腔镜辅助Malone手术治疗儿童完全性大便失禁的效果。方法回顾性分析2017年5月~2018年11月腹腔镜辅助Malone手术治疗直肠肛门疾病矫治术后保守治疗无效的完全性大便失禁8例资料。平均年龄9.2岁（6~14岁）。术后6个月以Schell评分评价手术效果，以大便失禁快速评价量表(Rapid Assessment Fecal Incontinence Score，RAFIS)评估排便功能。结果8例均顺利完成手术。平均手术时间84 min（65~110 min）。术后24 h开始流质饮食。随访时间6~24个月，平均16个月。1例术后2个月造瘘口狭窄，经间断扩张及放置支撑管后缓解，无造瘘口感染、出血、插管困难等并发症。术后1个月腹壁无明显瘢痕。每天灌肠1~2次，灌肠液200~500 ml，灌肠后30~45 min内可完成排便，两次排便期间无污粪。术后6个月Schell评分22~25分，（24.0±1.8）分；RAFIS量表从术前（19.0±1.0）分降至（4.3±0.7）分。结论腹腔镜辅助Malone手术治疗儿童顽固性完全大便失禁近期效果确切，远期效果及并发症需要进一步观察评价。
Abstract:
ObjectiveTo evaluate the therapeutic efficacy of laparoscopicassisted Malone operation for intractable fecal incontinence in children.MethodsA retrospective study was carried out on 8 cases of intractable fecal incontinence who underwent laparoscopic Malone operation in our department from May 2017 to November 2018. There were 4 males and 4 females, with an average age of 9.2 years old(range,6-14 years old). The effect of operation was evaluated by Schell score system, and the defecation function was evaluated by the Rapid Assessment Fecal Incontinence Score (RAFIS).ResultsAll the 8 cases underwent the laparoscopicassisted Malone operation successfully. The average operation time was 84 min (range, 65-110 min). Patients started oral nutrition at 24 hours after operation. The mean followup duration was 16 months (range, 6-24 months). One patient developed stoma stenosis at 2 months after operation, which was relieved by intermittent dilation by using a stent. No other complications occurred. There was no obvious scar on the abdominal wall at one month after operation. Enema was given 1-2 times a day, with enema liquid of 200-500 ml. Patients completed defecation 30-45 min after enema, without feces during two defecation periods. The score of Schell was 22-25 (24.0±1.8) and the score of Rafis was decreased from (19.0±1.0) to (4.3±0.7) at 6 months after operation.ConclusionsLaparoscopicassisted Malone operation has minimally invasive and cosmetic advantages. The shortterm effect of treatment of fecal incontinence is definite. The longterm effect and complications need further evaluation.

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金(81700497)；湖北省自然科学基金(2017CFB399)**通讯作者，Email：tshaotao83@126.com
更新日期/Last Update: 2020-04-03