Sacher P, Schwöbel M, Stauffer U G
Department of Surgery, University Children's Hospital, Zurich, Switzerland.
Eur J Pediatr Surg. 1992 Oct;2(5):277-80. doi: 10.1055/s-2008-1063458.
This is an update of a consecutive series of 19 patients with bladder exstrophy presented as a preliminary report 10 years ago with a follow-up of 6 years. The average time of follow-up now is 14 years. In difference to the former report several additional procedures have been performed in most patients. 3 early "good" patients stay "good and continent". Only 3 out of 5 patients categorized as "fair" are now "good and continent" and only one without further intervention. 3 out of 6 patients who were classified as "poor" are now diverted. The overall rate of secondary diversions is 40% including 2 patients with ureterosigmoidostomies. All patients have normal renal function and normal blood pressures. These results show that an early "good" result generally remains "good" but additional surgery may be warranted. The initially "fair" results usually necessitate a secondary procedure, e.g. augmentation cystoplasty or/and bladder neck tightening to show an improvement. Patients with early "poor" results unfortunately remain "poor" and have a great chance to get diverted.
这是对19例膀胱外翻患者连续系列病例的更新，该系列病例曾在10年前作为初步报告呈现，并进行了6年的随访。现在的平均随访时间为14年。与之前的报告不同，大多数患者都接受了一些额外的手术。3例早期“良好”的患者仍保持“良好且可控尿”状态。在5例分类为“尚可”的患者中，目前只有3例“良好且可控尿”，且只有1例无需进一步干预。6例分类为“差”的患者中有3例现在已改行尿流改道。二次尿流改道的总体发生率为40%，其中包括2例行输尿管乙状结肠吻合术的患者。所有患者的肾功能和血压均正常。这些结果表明，早期“良好”的结果通常会保持“良好”，但可能需要进行额外的手术。最初“尚可”的结果通常需要进行二次手术，例如膀胱扩大术或/和膀胱颈缩窄术以显示改善。不幸的是，早期“差”的结果的患者仍然“差”，并且有很大的改行尿流改道的可能性。
