Taghizadeh A, Qteishat A, Cuckow P M
Department of Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
Eur J Pediatr Surg. 2009 Jun;19(3):141-4. doi: 10.1055/s-0029-1192048. Epub 2009 Jun 4.
In cloacal exstrophy the hindgut is typically a blind ending segment attached to the exstrophy plate. This section of bowel may be mobilized, its continuity restored with the rest of the bowel, and used to fashion an end colostomy. We review our results using this approach.
A retrospective review of the outcomes was carried out on the basis of the case notes of nine consecutive patients with cloacal exstrophy who had been treated by restoration of hindgut continuity and an end colostomy.
The colostomy was fashioned at a median age of 17 days of life. The colostomy was formed as part of the primary repair in all but one patient in whom it was performed as a secondary procedure to treat a previously repaired, dehisced exstrophy repair where the hindgut had originally been left in situ. Seven patients had co-existing spinal anomalies and potentially neuropathic bowel. The median length of hindgut that was restored was 10 cm. Median interval until the stoma produced faeces was six days. There was stoma necrosis in one patient requiring early revision. Six patients underwent further subsequent bowel operations at a median interval of 9.1 months: four had colostomy revision but kept the hindgut, one had excision of the hindgut and a terminal ileostomy, and one had a pull-through operation that was subsequently further revised to an ileostomy.
Use of the hindgut loop in cloacal exstrophy to form a distal terminal colostomy is effective. Although stoma complications are common, these may be offset against the benefits of: restoration of hindgut electrolyte and fluid absorption; easier to mange stoma effluent; and the siting of the stoma on the left providing greater flexibility for future bladder reconstruction.
在泄殖腔外翻中，后肠通常是附着于外翻板的盲端节段。该肠段可被游离，与其余肠管恢复连续性，并用于制作末端结肠造口术。我们回顾了采用这种方法的结果。
基于9例连续接受后肠连续性恢复及末端结肠造口术治疗的泄殖腔外翻患者的病历进行了结局的回顾性分析。
结肠造口术在出生后中位年龄17天时施行。除1例患者外，结肠造口术均作为一期修复的一部分进行，该例患者是作为二期手术来治疗先前修复后裂开的外翻修复术，其原来后肠保留原位。7例患者合并脊柱畸形及潜在神经性肠病。恢复的后肠中位长度为10 cm。造口排出粪便的中位间隔时间为6天。1例患者出现造口坏死，需要早期修复。6例患者随后在中位间隔时间9.1个月时接受了进一步的肠道手术：4例进行了结肠造口术修复但保留了后肠，1例切除了后肠并做了末端回肠造口术，1例进行了拖出术，随后进一步改为回肠造口术。
在泄殖腔外翻中利用后肠袢形成远端末端结肠造口术是有效的。尽管造口并发症常见，但可被以下益处抵消：恢复后肠电解质和液体吸收；更易于处理造口排泄物；以及造口位于左侧为未来膀胱重建提供更大的灵活性。
