Frey P
Department of Pediatric Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
J Urol. 1996 Aug;156(2 Pt 2):812-5. doi: 10.1097/00005392-199608001-00072.
We report our clinical experience with anterior pelvic osteotomy in 16 patients who underwent surgery for bladder exstrophy. The technique and its difficulties are discussed.
Anterior pelvic osteotomy of the superior ramus of the public bone is a simple and efficient method to facilitate symphyseal approximation and abdominal wall closure without or with low tension on the suture lines in neonates who undergo surgery for bladder exstrophy. Older children in whom surgery has been delayed can also benefit from this method. Compared to other methods of osteotomy in exstrophy surgery it does not require additional incisions, nor does the patient need to be repositioned on the operating table. A successful operation does not depend on any particular orthopedic skills and it can easily be done by the pediatric urologist.
Immediate postoperative results regarding abdominal wall closure were excellent in all 16 patients. However, major postoperative complications developed in 2 patients. Despite antibiotic prophylaxis a severe soft tissue infection developed in 1 child, resulting in complete bladder dehiscence. In another patient an obturator nerve injury resulted in transient palsy, which resolved completely. While the first complication was not related to osteotomy, the second was osteotomy related.
Bilateral superior ramotomy of the pubic bones is a new alternative, easily performed technique to optimize bladder exstrophy surgery in children.
我们报告了16例接受膀胱外翻手术患者的骨盆前部截骨术的临床经验。讨论了该技术及其难点。
耻骨上支骨盆前部截骨术是一种简单有效的方法，可促进耻骨联合靠拢和腹壁闭合，对于接受膀胱外翻手术的新生儿，缝合线无张力或低张力。手术延迟的大龄儿童也可从该方法中获益。与膀胱外翻手术中的其他截骨方法相比，它不需要额外切口，患者也无需在手术台上重新定位。成功的手术不依赖任何特定的骨科技能，儿科泌尿外科医生可轻松完成。
所有16例患者术后腹壁闭合的即时效果均极佳。然而，2例患者出现了严重的术后并发症。尽管进行了抗生素预防，1名儿童仍发生了严重的软组织感染，导致膀胱完全裂开。另1例患者闭孔神经损伤导致短暂性麻痹，但已完全恢复。虽然第一种并发症与截骨术无关，但第二种与截骨术相关。
双侧耻骨上支截骨术是一种新的、易于实施的技术，可优化儿童膀胱外翻手术。
