Peña A
Department of Surgery, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.
J Pediatr Surg. 1997 Feb;32(2):263-7; discussion 267-8. doi: 10.1016/s0022-3468(97)90191-3.
The surgical treatment of persistent cloaca is a serious challenge. The operation is technically difficult and the final results for urinary and fecal function are far from excellent. The repair of a cloaca includes, among other maneuvers, the separation of the vagina from the urinary tract. This step is a serious technical challenge and is very time consuming. Devascularization of these structures is the main source of complications such as urethro-vaginal fistula, vaginal stricture, and acquired vaginal atresia. To avoid these complications and to facilitate the cloacal repair, a new technical variation using total urogenital mobilization was performed in 11 patients. In this procedure, after the rectum is separated from the vagina, both the urethra and the vagina are mobilized together as a single unit. The surgical time spent during the reconstruction was reduced by approximately 70%. All patients recovered well from the operations and have been followed up for 1 to 14 months. The blood supply of the vagina and urethra in all cases remained excellent. No patient developed urethrovaginal fistula, vaginal stricture, or acquired vaginal atresia. The cosmetic appearance in these patients is superior to the one achieved with previous techniques. Although this maneuver may not render better urinary or fecal control, the urethra is more accessible for catheterization. These preliminary results suggest that the total urogenital mobilization maneuver provides a definite technical advance in the repair of cloaca malformations.
持续性泄殖腔的外科治疗是一项严峻的挑战。该手术在技术上难度较大，而且泌尿和排便功能的最终结果远非理想。泄殖腔修复术包括多种操作，其中就有将阴道与泌尿道分离。这一步骤是一项严峻的技术挑战，且非常耗时。这些结构的血管离断是诸如尿道阴道瘘、阴道狭窄和后天性阴道闭锁等并发症的主要来源。为避免这些并发症并促进泄殖腔修复，对11例患者采用了一种新的技术变体——全泌尿生殖系统游离术。在此手术过程中，在直肠与阴道分离后，尿道和阴道作为一个整体一起游离。重建过程中所花费的手术时间减少了约70%。所有患者术后恢复良好，且已接受了1至14个月的随访。所有病例中阴道和尿道的血供均保持良好。没有患者出现尿道阴道瘘、阴道狭窄或后天性阴道闭锁。这些患者的外观优于采用先前技术所达到的效果。虽然这种操作可能不会带来更好的泌尿或排便控制，但尿道更便于进行插管。这些初步结果表明，全泌尿生殖系统游离术在泄殖腔畸形修复方面提供了明确的技术进步。
