Peña A, Kessler O
Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
J Pediatr Surg. 1998 Mar;33(3):407-12. doi: 10.1016/s0022-3468(98)90079-3.
The authors present nine cases of a unique defect in which urethra and vagina are fused together forming a urogenital sinus that deviates posteriorly and opens in the anterior rectal wall at the anus or immediately anterior to it. The rectum is essentially normal or may be minimally anteriorly mislocated. The authors call this defect posterior cloaca. The diagnosis requires a suspicious observer and a meticulous examination of the female genitalia. A complete urologic evaluation is mandatory because 88% of these patients have important associated urologic defects. Our patients were operated on via a posterior sagittal transanorectal approach, which allowed a full dissection and mobilization of urethra and vagina together to be placed in a normal location. Rectal dissection and mobilization was avoided to preserve bowel control. Seven patients enjoy bowel and urinary control. One patient was lost to follow-up, and one patient with a severely dysplastic sacrum suffers from fecal and urinary incontinence.
作者报告了9例一种独特的缺陷病例，其中尿道和阴道融合在一起形成一个泌尿生殖窦，该窦向后偏离并在肛门处或紧邻肛门的直肠前壁开口。直肠基本正常，或可能仅有轻微的向前移位。作者将这种缺陷称为后泄殖腔。诊断需要敏锐的观察者以及对女性生殖器进行细致检查。必须进行全面的泌尿外科评估，因为这些患者中有88%存在重要的相关泌尿系统缺陷。我们的患者通过经肛门后矢状入路进行手术，该方法允许将尿道和阴道一起充分游离并放置到正常位置。避免进行直肠游离以保留排便控制能力。7例患者排便和排尿功能正常。1例患者失访，1例患有严重发育不良骶骨的患者存在大便和小便失禁。
