Wang Zhe,Xie Xiaoli,He Qiuming,et al.Laparoscopic separation of urogenital sinus in intractable cloaca[J].Journal of Clinical Pediatric Surgery,,21():1019-1023.[doi:10.3760/cma.j.cn101785-202205074-004]
Laparoscopic separation of urogenital sinus in intractable cloaca
- Keywords:
- Anorectal Malformations; Cloaca; Anatomy; Histology; Minimally Invasive Surgical Procedures; Laparoscopes; Disorders of Sex Development
- Abstract:
- Objective To retrospectively review 4 cases of laparoscopic separation of urogenital sinus (UGS) as an adjuvant treatment for intractable cloacal malformations and explore the safety and effectiveness of this operation.Methods Clinical data of prenatal diagnosis, neonatal management and radical operation were reviewed for 4 patients with intractable cloaca.Basic demographics, anatomical characteristics, surgical approaches, operative duration, intraoperative hemorrhage, blood transfusion and perioperative complications were recorded.Results From 2016 to 2021, 4 children with intractable cloaca underwent laparoscopic UGS separation.Cases 1 to 3 had middle/high cloacal malformations and case 4 was reoperated.Cases 1 and 2 were diagnosed prenatally.Average length of common canal was 2.9 cm, average urethral length 0.68 cm and average vaginal length 2.4 cm.The average radical operative age was 21.3 months, operative weight 10.2 kg and average operative duration 8.8 h.Cases 1 and 2 were followed up for 36 months, case 3 for 23 months and case 4 for 9 months.There was no intraoperative complication.Case 2 had postoperative vaginal stenosis.The average postoperative hospital stay was 11.8 days.Conclusion As an adjuvant treatment, laparoscopic UGS separation is both safe and effective for urogenital sinus in intractable cloaca.It may simplify operative procedures and minimize tissue trauma.And it also aids in improving urinary incontinence after total urogenital mobilization and prevents vaginal replacement.
References:
[1] Wood RJ, Reck-Burneo CA, Dajusta D, et al.Cloaca reconstruction:a new algorithm which considers the role of urethral length in determining surgical planning[J].J Pediatr Surg, 2018, 53(1):90-95.DOI:10.1016/j.jpedsurg.2017.10.022.
[2] Fares AE, Marei MM, Abdullateef KS, et al.Laparoscopically assisted vaginal pull-through in 7 cases of congenital adrenal hyperplasia with high urogenital sinus confluence:early results[J].J Laparoendosc Adv Surg Tech A, 2019, 29(2):256-260.DOI:10.1089/lap.2018.0194.
[3] Fuchs J, Warmann SW, Seitz G, et al.Laparoscopically assisted vaginal pull-through for high urogenital sinus:a new surgical technique[J].Urology, 2012, 79(5):1180-1183.DOI:10.1016/j.urology.2012.01.009.
[4] Birraux J, Mouafo FT, Dahoun S, et al.Laparoscopic-assisted vaginal pull-through:a new approach for congenital adrenal hyperplasia patients with high urogenital sinus[J].Afr J Paediatr Surg, 2015, 12(3):177-180.DOI:10.4103/0189-6725.170191.
[5] Breech L.Gynecologic concerns in patients with cloacal anomaly[J].Semin Pediatr Surg, 2016, 25(2):90-95.DOI:10.1053/j.sempedsurg.2015.11.006.
[6] Georgeson KE, Inge TH, Albanese CT.Laparoscopically assisted anorectal pull-through for high imperforate anus-a new technique[J].J Pediatr Surg, 2000, 35(6):927-931.DOI:10.1053/jpsu.2000.6925.
[7] Liem NT, Quynh TA.Laparoscopic rectal pull-through for persistent cloaca:an easier approach for a complex anomaly[J].J Pediatr Surg, 2012, 47(4):815-818.DOI:10.1016/j.jpedsurg.2012.02.004.
[8] 王琛, 李龙, 郑伟, 等.腹腔镜技术在治疗一穴肛畸形手术中的应用[J].中华小儿外科杂志, 2015, 36(6):409-412.DOI:10.3760/cma.j.issn.0253-3006.2015.06.003. Wang C, Li L, Zheng W, et al.Laparoscopic-assisted anorectal pull-through for persistent cloaca[J].Chin J Pediatr Surg, 2015, 36(6):409-412.DOI:10.3760/cma.j.issn.0253-3006.2015.06.003.
[9] Ren XH, Xiao H, Li L, et al.Single-incision laparoscopic-assisted anorectoplasty versus three-port laparoscopy in treatment of persistent cloaca:a midterm follow-up[J].J Laparoendosc Adv Surg Tech A, 2018, 28(12):1540-1547.DOI:10.1089/lap.2018.0225.
[10] Wang C, Li L, Diao M, et al.Single-incision laparoscopic-assisted anorectoplasty for the management of persistent cloaca[J].J Laparoendosc Adv Surg Tech A, 2016, 26(4):328-333.DOI:10.1089/lap.2015.0296.
[11] Rintala RJ.Congenital cloaca:long-term follow-up results with emphasis on outcomes beyond childhood[J].Semin Pediatr Surg, 2016, 25(2):112-116.DOI:10.1053/j.sempedsurg.2015.11.011.
[12] Leclair MD, Gundetti M, Kiely EM, et al.The surgical outcome of total urogenital mobilization for cloacal repair[J].J Urol, 2007, 177(4):1492-1495.DOI:10.1016/j.juro.2006.11.055.
Memo
收稿日期:2022-05-24。
基金项目:广州市科技计划项目（202201010833）
通讯作者:钟微,Email:zhongwei@gwcmc.org