Ozcan C, Ulman I, Kara S, Avanoglu A, Kapubagli A, Gökdemir A
Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey.
J Urol. 2000 Jun;163(6):1932-5. doi: 10.1016/s0022-5347(05)67601-x.
We report our clinical experience with anterior diagonal iliac osteotomy in 10 patients who underwent surgery for bladder exstrophy. Technique and long-term results are discussed.
A total of 10 boys 1 month to 9 years old with bladder exstrophy underwent this procedure during a 2-year period.
None of the patients had bladder closure dehiscence or prolapse after the operation. There were neither infectious complications nor injury to the vessels or nerves in any case. Blood loss was minimal for anterior diagonal iliac osteotomy. The only significant complication in our series was the polypropylene erosion of the urethra, necessitating endoscopic removal in 1 patient 1 month postoperatively. All patients had wide diastasis of the pubis preoperatively (average pubic distance 53.3 cm., average pubic ratio 0.9). At surgery suturing the symphysis after bilateral osteotomy resulted in a satisfactory symphyseal approximation and tension-free closure of the abdominal wall was easily achieved in all cases. Radiological studies at a mean followup of 34.6 months (range 14.8 to 49.5) revealed significant recurrent diastasis of the pubic bones in all but 1 patient in whom bone grafts were applied between the iliac fragments. Mean interpubic distance was 42 cm. and mean pubic ratio was 0.6 at long-term followup.
Diagonal osteotomy may correct the principal bony deformity in exstrophy and enables initial symphyseal approximation. Pubic diastasis may recur, probably due to opening forces generated by soft tissue elements of the pelvis.
我们报告10例接受膀胱外翻手术的患者行髂前斜行截骨术的临床经验。并讨论了技术和长期结果。
在2年期间，共有10名年龄在1个月至9岁的男孩接受了膀胱外翻手术。
术后所有患者均未出现膀胱闭合裂开或脱垂。在任何情况下均未发生感染性并发症，也未损伤血管或神经。髂前斜行截骨术的失血量极少。我们系列中唯一的显著并发症是尿道聚丙烯侵蚀，1例患者在术后1个月需要内镜取出。所有患者术前耻骨均有明显分离（平均耻骨距离53.3 cm，平均耻骨比例0.9）。手术时，双侧截骨后缝合耻骨联合，耻骨联合近似满意，所有病例均能轻松实现腹壁无张力闭合。平均随访34.6个月（范围14.8至49.5个月）的影像学研究显示，除1例在髂骨碎片间应用骨移植的患者外，所有患者耻骨均有明显的复发性分离。长期随访时平均耻骨间距离为42 cm，平均耻骨比例为0.6。
斜行截骨术可纠正外翻的主要骨骼畸形，并能实现初始耻骨联合近似。耻骨分离可能复发，可能是由于骨盆软组织产生的张开力所致。
