Warne S A, Wilcox D T, Ransley P G
Department of Pediatric Urology, Great Ormond Street Children's Hospital/Institute of Child Health & Guy's Hospital, London, UK.
J Urol. 2002 Oct;168(4 Pt 2):1859-62; discussion 1862. doi: 10.1097/01.ju.0000030712.17096.0d.
Persistent cloaca is a complex malformation with variable presentation that remains a difficult reconstructive challenge. Previous reviews have concentrated on surgical technique, and data on long-term outcome are scarce. We evaluate long-term outcome and when possible correlate outcome with anatomy at presentation.
The records and radiographs of 64 patients 0.5 to 25 years old with persistent cloaca treated at 1 institution from 1975 to 2000 were retrospectively reviewed to determine the outcome for urinary and fecal continence. Outcome data were available in 61 girls as 3 died. Of these patients 11 were younger than 3 years, making evaluation of continence difficult, and so the remaining 50 patients constitute the study population. Mean patient age at review was 11.3 years (range 4 to 25).
Of the 50 patients 10 (20%) are incontinent of urine (4 with urinary diversion) and 40 (80%) are socially continent, including 11 (22%) who void spontaneously, 6 (12%) who perform clean intermittent catheterization alone and 23 (46%) who underwent reconstructive surgery. Fecal continence was achieved in 30 (60%) of patients and 40% are fecal incontinent or have a stoma.
The majority of patients born with a cloacal malformation can achieve social fecal and urinary control, although in 46% additional reconstructive surgery was required. The presence of a good bladder neck, short common channel, a normal sacrum and 2 normal kidneys indicates improved prognosis for urinary continence. Achieving normal voiding continence in a child with a cloacal malformation still represents an enormous surgical challenge.
持续性泄殖腔是一种表现多样的复杂畸形，仍是重建手术的难题。以往的综述集中在手术技术上，长期预后的数据很少。我们评估长期预后，并尽可能将预后与就诊时的解剖结构相关联。
回顾性分析1975年至2000年在1家机构接受治疗的64例0.5至25岁持续性泄殖腔患者的病历和X光片，以确定尿便失禁情况。61名女孩有预后数据，3名死亡。其中11名患者年龄小于3岁，评估失禁情况困难，因此其余50名患者构成研究人群。复查时患者平均年龄为11.3岁（范围4至25岁）。
50例患者中，10例（20%）尿失禁（4例有尿液改道），40例（80%）社会上能自主控制排尿，其中11例（22%）能自主排尿，6例（12%）仅行清洁间歇性导尿，23例（46%）接受了重建手术。30例（60%）患者实现了大便自控，40%的患者大便失禁或有造口。
大多数患有泄殖腔畸形的患者在社会层面上能实现大便和小便自控，尽管46%的患者需要额外的重建手术。膀胱颈良好、共同管短、骶骨正常和双肾正常提示尿失禁预后较好。在患有泄殖腔畸形的儿童中实现正常排尿自控仍然是一项巨大的手术挑战。
