Wang Zhe,Xie Xiaoli,He Qiuming,et al.Laparoscopic separation of urogenital sinus in intractable cloaca[J].Journal of Clinical Pediatric Surgery,2022,21(11):1019-1023.[doi:10.3760/cma.j.cn101785-202205074-004]
腹腔镜泌尿生殖窦分离术辅助治疗复杂泄殖腔畸形的临床应用
- Title:
- Laparoscopic separation of urogenital sinus in intractable cloaca
- Keywords:
- Anorectal Malformations; Cloaca; Anatomy; Histology; Minimally Invasive Surgical Procedures; Laparoscopes; Disorders of Sex Development
- 摘要:
- 目的 初步探讨腹腔镜泌尿生殖窦（urogenital sinus，UGS）分离术辅助治疗复杂泄殖腔畸形的安全性和有效性。方法 回顾广州市妇女儿童医疗中心2019年3月1日至2021年8月6日收治的4例复杂泄殖腔畸形患儿的产前诊断、新生儿期处理以及根治手术过程中的相关临床资料。总结患儿基本特点、解剖特点、手术技巧以及手术时间、术中出血量、围术期并发症及临床结局等情况。结果 4例复杂泄殖腔畸形患儿均行腹腔镜UGS分离术。病例1、病例2、病例3为中高位泄殖腔畸形，病例4为泄殖腔畸形再手术。病例1、病例2均于产前诊断。4例患儿平均共同通道长度为2.90 cm （0.80~3.60 cm），平均尿道长度为0.68 cm （0.80~1.00 cm），平均阴道长度为2.40 cm （1.50~4.50 cm）。平均根治手术年龄为21.30个月（6.40~54.50个月），平均手术体重为10.20 kg （6.50~16.20 kg），平均手术时间为8.80 h （6.80~9.70 h）。无一例出现术中并发症。平均术后住院时间为11.80天（7.00~15.00天）。病例1、病例2随访36个月，病例3随访23个月，病例4随访9个月；病例2术后出现阴道狭窄，其余患儿未发现术后并发症。结论 腹腔镜UGS分离术辅助治疗复杂泄殖腔畸形安全有效，可简化会阴操作，减少创伤，有助于改善传统尿生殖窦整体下移手术中膀胱颈下移导致的尿失禁，并避免阴道替代手术。
- 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.
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备注/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