Versteegh Hendt P, Sloots Cornelius E J, de Jong Justin R, Sleeboom Christien, Rassouli Roxana, van Heurn L W Ernest, van der Zee David C, Wijnen Rene M H, de Blaauw Ivo
Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
J Pediatr Surg. 2014 Apr;49(4):556-9. doi: 10.1016/j.jpedsurg.2013.10.028. Epub 2013 Nov 15.
Patients with a cloacal malformation generally undergo reconstructive surgery within the first years of life. However, the ideal age for surgery has rarely been mentioned. The aim of this study was to report differences in outcome between early (<6 months) and late repair of cloacal malformations.
Charts of patients with a cloacal malformation treated in 5 pediatric surgical centers between 1985 and 2009 were retrospectively studied for associated anomalies, postoperative complications, and colorectal and urological outcome.
Forty-two patients were eligible for this study, giving a mean exposure of less than 1 patient yearly per center. Forty-five percent of the patients had a short common channel (>3 cm), and 14% had a long common channel. Length of common channel was missing in 41% of the patients. Median age of the cloacal reconstruction was 9 months (range 1-121 months). Twelve patients (29%) underwent an early surgical repair (within the first 6 months of age; median 3 months), and 30 (71%) patients underwent a late repair (after 6 months of age; median 14 months). Eighteen postoperative complications (<30 days) had been documented in 15 patients (35%), with significant more perineal wound dehiscences in patients with an early repair (42% vs. 10%, p=0.031). There were no differences in complication rate between patients with short and long common channels. Mean follow-up was 142 months (range 15-289). At the last follow-up, 10 patients (24%) had voluntary bowel movements. Fourteen patients (33%) had complaints of soiling, 25 (60%) were constipated, with no differences between the early and late repair groups. Patients in the late repair group as well as the group of patients with a short common channel were more frequently able to void spontaneously.
Postoperative complications are common in patients with cloacal malformations. Early repair is associated with more wound dehiscences, however, without affecting long-term functional outcome. All centers had limited annual exposure of less than 1 patient. In these clinical settings, ideal age of cloacal reconstruction seems to be between 6 and 12 months. In general, centralized care for these complex malformations may be the crucial factor for reducing postoperative complications and better long-term outcome.
泄殖腔畸形患者通常在生命的头几年接受重建手术。然而，很少有人提及理想的手术年龄。本研究的目的是报告泄殖腔畸形早期（<6个月）和晚期修复的结果差异。
回顾性研究1985年至2009年期间在5个儿科手术中心接受治疗的泄殖腔畸形患者的病历，以了解相关异常、术后并发症以及结直肠和泌尿系统的结果。
42例患者符合本研究条件，每个中心每年平均接触不到1例患者。45%的患者有短共同通道（>3 cm），14%的患者有长共同通道。41%的患者共同通道长度缺失。泄殖腔重建的中位年龄为9个月（范围1-121个月）。12例患者（29%）接受了早期手术修复（在6个月龄内；中位年龄3个月），30例患者（71%）接受了晚期修复（6个月龄后；中位年龄14个月）。15例患者（35%）记录了18例术后并发症（<30天），早期修复患者的会阴伤口裂开明显更多（42%对10%，p=0.031）。短共同通道和长共同通道患者的并发症发生率没有差异。平均随访142个月（范围15-289个月）。在最后一次随访时，10例患者（24%）有自主排便。14例患者（33%）有便污主诉，25例（60%）便秘，早期和晚期修复组之间没有差异。晚期修复组以及短共同通道患者组更频繁地能够自主排尿。
泄殖腔畸形患者术后并发症很常见。早期修复与更多的伤口裂开相关，然而，不影响长期功能结果。所有中心每年接触的患者都有限，不到1例。在这些临床情况下，泄殖腔重建的理想年龄似乎在6至12个月之间。一般来说，对这些复杂畸形进行集中护理可能是减少术后并发症和获得更好长期结果的关键因素。
