Kurbet Santosh B, Prashanth Gowda P, Patil Mahantesh V, Mane Shivaji
Department of Pediatric Surgery, Dr. Prabhakar Kore Hospital and Medical Research Centre and KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
Department of Pediatrics, Dr. Prabhakar Kore Hospital and Medical Research Centre and KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
Indian J Plast Surg. 2013 Sep;46(3):549-54. doi: 10.4103/0970-0358.122015.
To study the problems faced during the surgery and follow-up of modified complete primary repair of exstrophy (CPRE) technique. Initial experience with CPRE and its short- and long-term outcomes with respect to continence status and psychosocial impact are reported.
A retrospective review of the hospital case records from March 2008 to September 2012 was performed. Data of patients with bladder exstrophy managed by a single paediatric surgeon using modified CPRE technique were analysed. Quality of life and psychosocial impact of the surgery were assessed using Pediatric Quality of Life Inventory (PedsQL 4.0) and compared with those of typical peers.
Eight children (age 4 days-12 years) underwent CPRE using modified Mitchell's technique. Two patients (25%) experienced early postoperative complications, with infection and fistula developing in one each. All the patients were doing well on follow-up, with variable continence rates and good cosmesis. Mean duration of follow-up was 18.5 months (range 6 months-4 years). Five out of seven (71%) children were continent or partially continent. One case was lost to follow-up. PedsQL scores were comparable with those of age-matched peers in all domains except the social functioning domain in 8-12 years age group (83.53 ± 9.70 vs. 77.86 ± 10.22, P < 0.05).
Our preliminary results with modified CPRE in neonates and children have been encouraging. No major complications were observed. Continence rate was satisfactory and cosmetic results were good. Though the technique is being practiced at several Indian centres, there is a paucity of comprehensive Indian data on CPRE.
研究改良完全性膀胱外翻一期修复术（CPRE）在手术及随访过程中面临的问题。报告CPRE的初步经验及其在控尿状态和心理社会影响方面的短期和长期结果。
对2008年3月至2012年9月的医院病例记录进行回顾性分析。分析由一名小儿外科医生采用改良CPRE技术治疗膀胱外翻患者的数据。使用儿童生活质量量表（PedsQL 4.0）评估手术的生活质量和心理社会影响，并与典型同龄人进行比较。
8名儿童（年龄4天至12岁）采用改良的米切尔技术接受了CPRE手术。2例患者（25%）术后早期出现并发症，各有1例发生感染和瘘管。所有患者随访情况良好，控尿率各异，美容效果良好。平均随访时间为18.5个月（范围6个月至4年）。7名儿童中有5名（71%）控尿或部分控尿。1例失访。除8至12岁年龄组的社会功能领域外，所有领域的PedsQL评分与年龄匹配的同龄人相当（83.53±9.70对77.86±10.22，P<0.05）。
我们在新生儿和儿童中采用改良CPRE的初步结果令人鼓舞。未观察到重大并发症。控尿率令人满意，美容效果良好。尽管该技术在印度的几个中心都在开展，但关于CPRE的全面印度数据却很匮乏。
