探讨Malone手术结合肠道管理系统，治疗儿童器质性大便失禁(FI)后，对其排便功能及生活质量(QoL)的影响。

选择2017年1月至2020年1月，广州市妇女儿童医疗中心接受该方案治疗的9例器质性FI患儿为研究对象，回顾性分析其临床病例资料。采用Schell评分表，评价Malone手术效果；采用儿童生活质量测定量表(PedsQL) 4.0，评价该方案治疗前、后患儿的QoL；采用大便失禁快速评价量表(RAFIS)，评价患儿该方案治疗前、后排便功能。这3个量表共同评估Malone手术结合肠道管理系统，治疗器质性FI患儿的临床效果。采用配对t检验，对患儿治疗前、后PedsQL 4.0及RAFIS评分结果进行统计学比较。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求，所有患儿监护人签署临床研究知情同意书。

①对这9例患儿采用Malone手术结合肠道管理系统治疗后，1例(11.1%)无肛周污粪；5例(55.6%)仍有肛周污粪(<1次/周)；1例(11.1%)造瘘口狭窄合并肛周污粪(>2次/周)；其余2例(22.2%)造瘘口感染或瘘口回缩合并肛周污粪(均<1次/周)。Malone手术后，9例患儿均未出现其他并发症。②这9例患儿中，8例(88.9%)术后Schell评分为(23.4±1.0)分，1例(11.1%)为14.0分；9例患儿PedsQL 4.0及RAFIS治疗前评分分别为(19.4±9.0)分、(18.7±0.9)分，显著高于治疗后的(4.0±4.0)分、(3.6±2.3)分，并且差异均有统计学意义(t＝5.907、P＝0.004，t＝18.338、P<0.001)。

Malone手术结合肠道管理系统治疗，可以极大改善器质性FI患儿的QoL，临床疗效较好，为目前临床治疗儿童器质性FI可供选择的方法。

To investigate effect of Malone operation combined with bowel management program in treatment of organic fecal incontinence (FI) in children on their defecation function and quality of life (QoL).

From January 2017 to January 2020, a total of 9 children with organic FI treated by this integrated scheme in Guangzhou Women and Children′s Medical Center were selected as research subjects, and their clinical case data were analyzed retrospectively. Schell scale was used to evaluate effect of Malone operation. Pediatric quality of life inventory (PedsQL) 4.0 was used to evaluate the QoL of children before and after treatment, and the rapid assessment of fecal incontinence scale (RAFIS) was used to evaluate defecation function of children before and after treatment. These three scales were used to evaluate the clinical effect of Malone operation combined with bowel management program in treatment of children with organic FI. The PedsQL 4.0 and RAFIS scores between before and after treatment of children were compared statistically by paired t test. This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and informed contents were obtained from all guardians.

① After 9 children were treated with Malone operation combined with bowel management program, 1 case (11.1%) did not have perianal feces, and 5 cases (55.6%) still had perianal feces (< once a week); One case (11.1%) had stricture of stoma with perianal feces (> twice a week); the other 2 cases (22.2%) had stoma infection or retraction with perianal feces (all < once/week). None of 9 children had other complications after Malone operation. ② Among the 9 children, 8 cases (88.9%) had a postoperative Schell score of (23.4±1.0) scores, and 1 case (11.1%) had 14.0 scores. The scores of PedsQL 4.0 and RAFIS of 9 children before treatment were (19.4±9.0) scores and (18.7±0.9) scores respectively, which were significantly higher than those of (4.0±4.0) scores and (3.6±2.3) scores after treatment, and the differences were statistically significant (t=5.907, P=0.004; t=18.338, P<0.001).

Malone operation combined with bowel management program in treatment of children with organic FI can greatly improve their QoL and has good clinical efficacy. It is an optional method for treatment of children with organic FI at present.