López Alvarez-Buhilla P, Torres Piedra C, Blanco Bruned J, Emparan G De Salazar C, Castro Laiz C
Servicio de Cirugía Pediátrica, Hospital de Cruces, Bilbao.
An Esp Pediatr. 2001 Dec;55(6):573-5.
Persistent cloaca is one of the most complex forms of anorectal malformation in girls. Surgical treatment is complicated and laborious especially when the common channel is long. The aim of this report was to emphasize the importance of the joint mobilization of the urogenital sinus after separation from the rectum. This maneuver avoids separation of the urinary tract from the genital tract and reduces operating time by more than 60 %. This is only possible when the common channel of the cloaca is less than 3 cm. We present the cases of two girls treated in the last 2 years with this technique. Operating time was significantly shortened to approximately 4 hours and the procedure was considerably simplified. The functional and cosmetic results were excellent. To obtain good results in the treatment of cloaca, a precise clinical and radiologist diagnosis must be made, surgical needs should be prioritized and the appropriate technique chosen. The best procedure for patients whose common channel is less than 3 cm is total mobilization of the urogenital sinus, subsequently sutured to the perineum, and placement the rectum within the anorectal sphincter complex.
泄殖腔存留是女童最复杂的肛门直肠畸形形式之一。手术治疗复杂且费力，尤其是当共同管较长时。本报告的目的是强调在直肠分离后对泌尿生殖窦进行联合游离的重要性。该操作可避免尿路与生殖道分离，并将手术时间缩短60%以上。这仅在泄殖腔的共同管小于3厘米时才可行。我们介绍了过去两年采用该技术治疗的两名女童的病例。手术时间显著缩短至约4小时，手术过程也大为简化。功能和美容效果极佳。为了在泄殖腔治疗中取得良好效果，必须进行精确的临床和放射科诊断，优先考虑手术需求并选择合适的技术。对于共同管小于3厘米的患者，最佳手术方法是完全游离泌尿生殖窦，随后缝合至会阴，并将直肠置于肛门直肠括约肌复合体中。
