Benz Karl S, Jayman John, Maruf Mahir, Joice Gregory, Kasprenski Matthew, Sopko Nikolai, Di Carlo Heather, Gearhart John P
Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD.
Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD.
Urology. 2018 Jul;117:137-141. doi: 10.1016/j.urology.2018.04.011. Epub 2018 Apr 25.
To evaluate human acellular dermis (HAD) as an adjunct during bladder neck transection (BNT) by comparing surgical outcomes with other types of tissue interposition.
A prospectively maintained institutional database of exstrophy-epispadias complex (EEC) patients was reviewed for those who underwent a BNT with at least 6 months follow-up. The primary outcome was the occurrence of BNT-related fistulas.
In total, 147 EEC patients underwent a BNT with a mean follow-up time of 6.9 years (range 0.52-23.35 years). There were 124 (84.4%) classic exstrophy patients, 22 (15.0%) cloacal exstrophy patients, and 1 (0.7%) penopubic epispadias patient. A total of 12 (8.2%) BNTs resulted in fistulization, including 4 vesicoperineal fistulas, 7 vesicourethral fistulas, and 1 vesicovaginal fistula. There were 5 (22.7%) fistulas in the cloacal exstrophy cohort and 7 (5.6%) fistulas in the classic bladder exstrophy cohort (P = .019). Using either HAD or native tissue flaps resulted in a lower fistulization rate than using no interposed layers (5.8% vs 20.8%; P = .039). Of those with HAD, the use of a fibrin sealant did not decrease fistulization rates when compared to HAD alone (6.5% vs 8.8%, P = .695). There was no statistical difference in surgical complications between the use of HAD and native flaps (8.6% vs 5%, P = .716).
Use of soft tissue flaps and HAD is associated with decreased fistulization rates after BNT. HAD is a simple option and an effective adjunct that does not require harvesting of tissues in patients where a native flap is not feasible.
通过比较膀胱颈横断术（BNT）的手术结果与其他类型组织植入的情况，评估人脱细胞真皮（HAD）在膀胱颈横断术中作为辅助材料的作用。
回顾前瞻性维护的机构性膀胱外翻-尿道上裂综合征（EEC）患者数据库，纳入接受膀胱颈横断术且随访至少6个月的患者。主要结局是与膀胱颈横断术相关的瘘管形成情况。
共有147例EEC患者接受了膀胱颈横断术，平均随访时间为6.9年（范围0.52 - 23.35年）。其中经典型膀胱外翻患者124例（84.4%），泄殖腔外翻患者22例（15.0%），阴茎耻骨型尿道上裂患者1例（0.7%）。总共12例（8.2%）膀胱颈横断术导致瘘管形成，包括4例膀胱会阴瘘、7例膀胱尿道瘘和1例膀胱阴道瘘。泄殖腔外翻队列中有5例（22.7%）瘘管形成，经典型膀胱外翻队列中有7例（5.6%）瘘管形成（P = 0.019）。使用HAD或自体组织瓣导致的瘘管形成率低于未使用植入层的情况（5.8%对20.8%；P = 0.039）。在使用HAD的患者中，与单独使用HAD相比，使用纤维蛋白密封剂并未降低瘘管形成率（6.5%对8.8%，P = 0.695）。使用HAD和自体组织瓣的手术并发症之间无统计学差异（8.6%对5%，P = 0.716）。
使用软组织瓣和HAD与膀胱颈横断术后瘘管形成率降低相关。HAD是一种简单的选择，也是一种有效的辅助材料，在无法使用自体组织瓣的患者中无需采集组织。
