Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
J Pediatr Surg. 2011 Dec;46(12):2316-20. doi: 10.1016/j.jpedsurg.2011.09.023.
The transpubic approach has been used mainly to treat urethral injuries and prostate cancer. There are no reports describing this approach in anorectal malformations.
Forty-two patients who underwent a transpubic approach for their genitourinary/colorectal reconstruction were reviewed. Indications, complications, and follow-up were analyzed. A midline infraumbilical incision was used. The pubic cartilage was divided with needle cautery. Institutional review board approval was obtained (IRB# 2008-1317).
The cases included complex malformations (16), covered exstrophy (15), long urogenital sinus with normal rectum (6), and reoperations in cloacas which had been left with persistent fistulae between vagina and urinary tract with normal rectum (5). Excellent exposure was achieved in all cases, allowing successful anatomical reconstruction. Functional results varied depending on the specific type of defect but were not expected to be good due to severe congenital or acquired anatomic defects. There were 3 complications related to the transpubic approach: pubic dehiscence, suspected osteomyelitis, and bleeding.
The transpubic approach should be considered for the repair of complex anorectal and urogenital malformations, especially when adequate exposure cannot be achieved with an abdominal, perineal, or posterior sagittal approach. Another ideal indication is in patients with a normal rectum who were born with a complex urogenital sinus or underwent a failed attempted repair but were left with problems requiring reoperation in a scarred and fibrotic pelvis.
耻骨后入路主要用于治疗尿道损伤和前列腺癌。目前尚无关于该入路在肛门直肠畸形中的应用报道。
对 42 例行耻骨后入路泌尿生殖/结直肠重建的患者进行回顾性分析。分析其适应证、并发症和随访情况。采用中线脐下切口，用针状电烙器切开耻骨软骨。本研究获得机构审查委员会批准（IRB# 2008-1317）。
病例包括复杂畸形（16 例）、覆盖性膀胱外翻（15 例）、长型尿生殖窦伴正常直肠（6 例）和因阴道与泌尿道间持续瘘管而遗留的 cloaca 再次手术（5 例，直肠正常）。所有病例均获得良好暴露，实现了成功的解剖重建。由于存在严重的先天性或获得性解剖缺陷，功能结果因具体畸形类型而异，预计不会很好。耻骨后入路有 3 种相关并发症：耻骨分离、疑似骨髓炎和出血。
耻骨后入路可考虑用于修复复杂的肛门直肠和泌尿生殖畸形，尤其是在腹部、会阴或后矢状入路无法获得充分显露时。另一个理想的适应证是对于直肠正常但存在复杂尿生殖窦或曾行失败修复手术且遗留问题需要在瘢痕化和纤维化骨盆中再次手术的患者。
