Wang Rui,Peng Kun,Ma Tidong,et al.Individualized surgical management and rehabilitation of perineal single-orifice cloaca in infants and young children[J].Journal of Clinical Pediatric Surgery,2025,(08):741-744.[doi:10.3760/cma.j.cn101785-202310049-007]
婴幼儿一穴肛个体化手术与康复初探
- Title:
- Individualized surgical management and rehabilitation of perineal single-orifice cloaca in infants and young children
- Keywords:
- Anorectal Malformations; Cloaca With Single Perineal Orifice; Surgical Procedures; Operative; Enterostomy; Individualized Treatment; Defecation; Urination; Treatment Outcome
- 摘要:
- 目的 总结婴幼儿一穴肛的个体化手术与康复及随访经验,为婴幼儿一穴肛诊治提供参考。方法 回顾性分析中南大学湘雅医学院附属儿童医院(湖南省儿童医院)2016年10月至2023年10月收治的5例一穴肛患儿临床资料,收集患儿术前临床资料、诊断方法、手术方式以及术后康复、长期随访情况。结果 5例均为女性,首诊时间均为出生后1 d,确诊后均先行横结肠造瘘术,手术时日龄2~6 d。5例经膀胱镜测量共同管(common channel,CC)长度分别为1.6 cm、2.0 cm、2.5 cm、3.0 cm、4.0 cm;尿道长度分别为2.3 cm、3.0 cm、3.2 cm、3.4 cm、4.5 cm;阴道长度分别为2 cm、2.8 cm、3 cm、3.1 cm、4.5 cm。5例均接受个体化根治手术,其中2例行后矢状入路骶会阴肛门成形术(posterior sagittal anorectoplasty,PSARP)联合尿生殖窦整体游离移位术(total urogenital mobilization,TUM),3例行腹腔镜辅助下肛门成形术(laparoscopically assisted anorectoplasty,LAARP)+TUM;术后无一例发生严重并发症。排尿功能评分:1例未满2岁未评分,2例评分为Ⅱ级,2例评分为Ⅰ级;关瘘后3个月膀胱残余尿量均≤8 mL。5例中2例接受排便功能评分:1例6分,1例5分。结论 婴幼儿一穴肛采取个体化诊治与康复策略,可获得相对满意的临床疗效,适合在临床推广。
- Abstract:
- Objective To summarize individualized surgical techniques,postoperative rehabilitation,and follow-up for perineal single-orifice cloaca in infants and young children,providing a reference for its diagnosis and treatment. Methods The clinical data of 5 patients with single-orifice cloaca treated at Hunan Children‘s Hospital between October 2016 and October 2023 were reviewed retrospectively.Pre-operative findings,diagnostic work-up,operative procedures,postoperative rehabilitation,and long-term follow-up were collected and analyzed. Results All 5 patients were female and first evaluated on day 1 of life.After definitive diagnosis,transverse colostomy was performed at 2-6 days of age.Cystoscopy revealed common channel (CC) lengths of 1.6 cm,2.0 cm,2.5 cm,3.0 cm,and 4.0 cm;urethral lengths of 2.3 cm,3.0 cm,3.2 cm,3.4 cm,and 4.5 cm;and vaginal lengths of 2.0 cm,2.8 cm,3.0 cm,3.1 cm,and 4.5 cm,respectively.Individualized definitive repair was carried out:posterior sagittal anorectoplasty (PSARP) plus total urogenital mobilization (TUM) in two cases,and laparoscopically assisted anorectoplasty (LAARP) plus TUM in three cases.No severe postoperative complications occurred.Voiding function scores showed two cases in Grade Ⅱ and two cases in Grade Ⅰ (one infant <2 years old was not scored).Bladder residual volume ≤ 8 mL was recorded 3 months after stoma closure in all patients.Bowel function assessment yielded scores of 6 and 5 in two evaluable children. Conclusions Individualized treatment and rehabilitation for perineal single-orifice cloaca in infants and young children achieves satisfactory clinical outcomes and is suitable for broader clinical application.
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备注/Memo
收稿日期:2023-10-27。
基金项目:湘财社指[2024]0083号
通讯作者:王睿,Email:15189690@qq.com