Department of Pediatric Surgery, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi, India.
J Pediatr Urol. 2012 Aug;8(4):375-8. doi: 10.1016/j.jpurol.2011.07.011. Epub 2011 Aug 27.
Urethrovaginal disruption injury poses a considerable challenge in surgical correction, mainly due to difficult access to the receded urethrovaginal unit deep in the scarred anterior perineum. We assessed the feasibility, safety and efficacy of the anterior sagittal transanorectal approach (ASTRA) in the repair of anterior perineal injury with urethrovaginal disruption in female children.
Three girls with urethrovaginal disruption following perineal injury were operated by ASTRA between March 2008 and December 2010. All of them had severe scarring of the anterior perineum at the time of definitive repair by this approach. One underwent ASTRA repair without a covering colostomy.
Total urethrovaginal mobilization and anchorage of urethral and vaginal orifices at the vestibule were successfully achieved in all patients. One patient has developed vaginal stenosis at 1.5 years follow up. Despite the absence of a colostomy cover in one case, there were no wound complications in the early postoperative period.
The ASTRA is safe and efficacious in the repair of traumatic urethrovaginal disruption in children.
尿道阴道撕裂伤的外科修复极具挑战性，主要是因为难以进入深陷在瘢痕化的前会阴中的回缩的尿道阴道单位。我们评估了经肛门前矢状入路（ASTRA）在女性儿童会阴损伤伴尿道阴道撕裂伤修复中的可行性、安全性和疗效。
2008 年 3 月至 2010 年 12 月，采用 ASTRA 对 3 例因会阴损伤导致尿道阴道撕裂的女孩进行了手术。所有患者在通过该入路进行确定性修复时均存在严重的前会阴瘢痕化。其中 1 例患者未行覆盖性结肠造口术。
所有患者均成功实现了尿道阴道的整体游离和将尿道及阴道开口固定于前庭。1 例患者在随访 1.5 年后出现阴道狭窄。尽管有 1 例病例未行结肠造口覆盖，但术后早期无伤口并发症。
ASTRA 是一种安全有效的治疗儿童外伤性尿道阴道撕裂伤的方法。
