CAJ | 학술논문

目的：探讨一期手术修复在婴幼儿膀胱外翻尿道上裂综合征治疗中的应用及疗效。方法9例膀胱外翻尿道上裂综合征患者，均为男性，年龄3 d～1岁，平均年龄21．3 w。全部采用 Mitchell 法完全一期修复手术，腹膜外充分游离膀胱，将膀胱、膀胱颈及尿道一同关闭，均未行骨盆截骨术，术后采取适当制动，用改良 Cantwell-Ransley 法修复尿道上裂。结果9例膀胱外翻尿道上裂综合征患者中7例均一期修复成功，2例膀胱、腹壁裂开，其中1例已行可控尿流改道术。3例患儿术后出现轻度切口感染，经换药及抗炎治疗后愈合良好，无一例出现龟头或海绵体缺血坏死，无尿瘘、尿道狭窄及尿道下裂等并发症。术后阴茎外观满意，平均随访1a，肾功均正常，无一例出现膀胱输尿管返流。结论一期手术治疗婴幼儿膀胱外翻尿道上裂综合征疗效可靠，并发症少，临床可推广使用。应根据外翻膀胱大小、耻骨分离程度、患儿一般情况等选择行一期手术修复。
목적：탐토일기수술수복재영유인방광외번뇨도상렬종합정치료중적응용급료효。방법9례방광외번뇨도상렬종합정환자，균위남성，년령3 d～1세，평균년령21．3 w。전부채용 Mitchell 법완전일기수복수술，복막외충분유리방광，장방광、방광경급뇨도일동관폐，균미행골분절골술，술후채취괄당제동，용개량 Cantwell-Ransley 법수복뇨도상렬。결과9례방광외번뇨도상렬종합정환자중7례균일기수복성공，2례방광、복벽렬개，기중1례이행가공뇨류개도술。3례환인술후출현경도절구감염，경환약급항염치료후유합량호，무일례출현구두혹해면체결혈배사，무뇨루、뇨도협착급뇨도하렬등병발증。술후음경외관만의，평균수방1a，신공균정상，무일례출현방광수뇨관반류。결론일기수술치료영유인방광외번뇨도상렬종합정료효가고，병발증소，림상가추엄사용。응근거외번방광대소、치골분리정도、환인일반정황등선택행일기수술수복。
Objective To explore the application and curing effects of the primary complete repair in bladder exstrophy epispadias syndrome in infants.Methods A total of 9 male patients with bladder exstrophy epispadias syndrome underwent neonatal or delayed (more than 30 days)primary closure without pelvic osteotomies.By full extraperitoneal mobilization,bladder,bladder neck and urethra were closed as a single unit,with proper postoperative immobilization.A modified Cantwell-Ransly technique was applied to repair epispadias.Results 7 boys were successfully treated with this procedure.There were 2 cases of de-hiscence of anterior abdominal wall and bladder,with controllable urinary diersion on one of the 2.Mild in-fection of incision occurred in 3 boys,but with good healing effects after the drug treatment and anti-in-flammatory treatment.There was no urinary fistula,urethral stricture,hypospadias,ischemic necrosis of the glans penis or sponge on all boys.All patients had normal conical symmetric glans,with normal serum creatinine level and without vesicoureteral reflux through a 1-year follow-up study.Conclusion Complete primary closure of bladder exstrophy should be conducted according to the size of bladder plate,the degree of symphyseal diastasis and the nutritional condition of the neonate,which is important to avoid the post-operative complications and improve the surgical outcome.