Xu Weijue,Lü Zhibao,Lü Yiqing,et al.Clinical study for precise claaification and surgical treatment of cloaca[J].Journal of Clinical Pediatric Surgery,,19():891-896.[doi:10.3969/j.issn.1671-6353.2020.10.006]
Clinical study for precise claaification and surgical treatment of cloaca
- CLC:
- R726.1;R726.2;R657.1
- Abstract:
- Objective To explore the relationship between the precise classification of cloaca malformation and the surgical repair of complex cloacas with minimal damage.Methods Clinical data were retrospective reviewed for 22 girls with cloaca malformation undergoing operations within the last 9 years.The length of common channel (CC),urethra,vagina and the location of rectal termination were detected through angiography,magnetic resonance imaging (MRI),cystoscopy and corresponding surgical approaches were retrospectively reviewed. Results CC was >3 cm(n=1) and ≤3 cm(n=21); length of urethra ≥2 cm(n=12) and <2 cm(n=10); length of vagina ≥3 cm(n=11) and <3 cm(n=11).Seven cases had bicornuate uterus and duplicate Mullerian systems.Two cases of severe hydrocolpos were treated.Rectal termination was located at the junctions of urethra & vagina (n=13),distal vagina & urethra (n=2),duplicate Mullerian systems (n=1),vagina or cervix (n=5) and bladder (n=1).One patient underwent transabdominal vaginoplasty and urethroplasty through vaginal switch; posterior sagittal anorectoplasty (PASAP) plus total urogenital mobilization/partial urogenital mobilization (TUM/PUM,n=14); laparoscopically assisted anorectoplasty (LAARP) plus TUM/PUM (n=5) and anoplasty only (n=2).There were no serious postoperative complications.Postoperative follow-ups were evaluated by the Krickenbeck standard.Ten children (50%) earned >9 points with excellent defecation function.Above 6 points hinted that decent defecation function.Conclusion Accurate classification of cloaca is essential for selecting optimal surgical approaches.And angiography,MRI and cystoscopy can help to detect the length of CC,urethra and vagina and the /locations of rectal termination,vaginas and bladder.Multi-disciplinary consultations are vital for preoperative planning,surgery and follow-ups.
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Memo
收稿日期:2020-03-09。
通讯作者:吕志宝,Email:lvzb@shchildren.com.cn