量两次，切一次：比较内镜和 3D 会阴造影在直肠阴道畸形患者共同腔道和尿道测量中的应用。
Measure twice and cut once: Comparing endoscopy and 3D cloacagram for the common channel and urethral measurements in patients with cloacal malformations.
机构信息
Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, Unites States.
Seattle Children's Hospital, Seattle, Washington, United States.
出版信息
J Pediatr Surg. 2020 Feb;55(2):257-260. doi: 10.1016/j.jpedsurg.2019.10.045. Epub 2019 Nov 5.
INTRODUCTION
Precise and accurate measurement of the common channel and urethra is a critical determinant prior to the repair of cloacal malformations. Endoscopy and 3D reconstruction cloacagram are two common modalities utilized to help plan the surgical approach, however the consistency between these methods is unknown.
METHODS
Common channel and urethral lengths obtained by endoscopy and 3D cloacagram of cloaca patients at six pediatric colorectal centers were compared. Data are given as mean (range).
RESULTS
72 patients were included in the study. Common channel measurements determined by 3D cloacagram and endoscopy were equal in 7 cases (10%). Endoscopic measurements of the common channel were longer than 3D cloacagram in 20 (28%) cases and shorter in the remaining 44 (62%) cases. The absolute difference between measurements of the common channel was 7.2 mm (0-2.4 cm). Urethral measurements by both modalities were equal in 8 cases (12%). Endoscopic measurement of the urethra was longer than that by 3D cloacagram in 20 (31%) patients and shorter in 37 (57%) of cases. The absolute difference between measurements of the urethra was 5.1 mm (0-2.0 cm). The reconstruction (e.g. TUM or urogenital separation) that would be performed according to measurements determined by 3D cloacagram and endoscopic measurements differed in 13/62 (21%) patients with each structure identified and common channel measurements of >1 cm.
CONCLUSION
Significant variation exists in the measurements of the common channel and urethra in patients with cloacal malformations as determined by endoscopy and 3D cloacagram. This variation should be considered as these measurements influence the decision to perform either a TUM or urogenital separation. Based on these findings, 3D cloacagram should be performed in all patients prior to cloaca repair to prevent mischaracterization of the malformation.
LEVEL OF EVIDENCE
Level IV.
简介
在修复直肠阴道畸形之前，精确和准确地测量共同通道和尿道是一个关键决定因素。内窥镜检查和 3D 重建 Cloacagram 是两种常用的方法，可帮助计划手术方法，但是这些方法之间的一致性尚不清楚。
方法
比较了六个小儿结直肠中心 Cloaca 患者的内窥镜和 3D Cloacagram 获得的共同通道和尿道长度。数据以平均值（范围）给出。
结果
该研究纳入了 72 例患者。3D Cloacagram 和内窥镜检查确定的共同通道测量值在 7 例（10％）中相等。内窥镜检查的共同通道测量值长于 3D Cloacagram 的有 20 例（28％），而其余 44 例（62％）则较短。共同通道测量值的绝对差异为 7.2mm（0-2.4cm）。两种方法的尿道测量值相等的有 8 例（12％）。内窥镜检查的尿道测量值长于 3D Cloacagram 的有 20 例（31％），短于 37 例（57％）。尿道测量值的绝对差异为 5.1mm（0-2.0cm）。根据 3D Cloacagram 和内窥镜检查确定的测量值，会进行重建（例如 TUM 或泌尿生殖分离），在 62 例（21％）患者中，两种结构均存在差异，且共同通道测量值>1cm。
结论
通过内窥镜检查和 3D Cloacagram 确定的 Cloaca 畸形患者的共同通道和尿道的测量值存在显著差异。在进行 TUM 或泌尿生殖分离之前，应考虑到这些差异，因为这些测量值会影响进行 TUM 或泌尿生殖分离的决定。基于这些发现，在进行 Cloaca 修复之前，应在所有患者中进行 3D Cloacagram，以防止对畸形的错误描述。
证据水平
四级。
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