Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Baltimore, MD, USA; Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA.
Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institutions, Johns Hopkins Hospital, Baltimore, MD, USA; Johns Hopkins Medical Institutions, Charlotte Bloomberg Children's Hospital, Baltimore, MD, USA.
J Pediatr Surg. 2019 Nov;54(11):2416-2420. doi: 10.1016/j.jpedsurg.2019.02.012. Epub 2019 Feb 26.
Cloacal exstrophy (CE) is the most severe presentation of the Exstrophy-Epispadias Complex (EEC) and is associated with an omphalocele, making the bladder and abdominal wall closure difficult. If the bladder closure fails, a secondary closure is necessary. The objective of this study is to identify patient or surgical factors associated with a successful secondary closure.
The institution's EEC database was reviewed for CE patients between 1975 and 2015. Inclusion criteria included a failed primary bladder closure with a secondary closure. Patient demographics, surgical factors and outcomes of the secondary bladder closure were reviewed.
Twenty-four patients met inclusion criteria. 8/8 patients had a successful two-staged closure at the author's institution (100%); 2/16 patients had a successful closure at an outside institution (12.5%). Older median age at secondary closure was associated with outcome, p = 0.045. Pelvic osteotomy was associated with successful secondary closure, p = 0.013. Using Buck's immobilization with external fixation was associated with a higher proportion of successful secondary closures compared to Spica cast, p = 0.012.
Successful reclosure in CE patients is associated with the use of osteotomy as well as Buck's immobilization with external fixation. While successful reclosure can be achieved, it is often at the cost of multiple procedures and, therefore, all efforts should be expended to achieve a successful primary closure.
Prognostic.
III.
直肠外翻（CE）是外胚层-尿道上裂复合畸形（EEC）中最严重的表现形式，常伴有脐膨出，使得膀胱和腹壁的关闭变得困难。如果膀胱关闭失败，则需要进行二次关闭。本研究的目的是确定与二次成功关闭相关的患者或手术因素。
回顾了 1975 年至 2015 年间本机构的 EEC 数据库中 CE 患者的资料。纳入标准包括初次膀胱关闭失败且进行了二次关闭。回顾了患者的人口统计学、手术因素和二次膀胱关闭的结果。
24 名患者符合纳入标准。在作者所在机构，8/8 名患者（100%）进行了两阶段成功关闭；在其他机构，16 名患者中有 2 名（12.5%）成功关闭。二次关闭时的中位年龄较大与结局相关，p=0.045。骨盆切开术与二次关闭的成功相关，p=0.013。与 Spica 石膏固定相比，使用 Buck 固定术联合外固定架固定与更高比例的二次关闭成功相关，p=0.012。
CE 患者的再关闭与骨盆切开术以及 Buck 固定术联合外固定架固定有关。虽然可以实现成功的再关闭，但通常需要多次手术，因此应尽一切努力实现成功的初次关闭。
预后。
III。
