修改新生儿泄殖腔手术:不触动盲肠板

Pub Date : 2024-10-21 eCollection Date: 2024-01-01 DOI:10.1055/s-0044-1791814
Elizaveta Bokova, Shimon E Jacobs, Laura Tiusaba, Christina P Ho, Briony K Varda, Hans G Pohl, Christina Feng, Victoria A Lane, Caitlin A Smith, Andrea T Badillo, Richard J Wood, Marc A Levitt
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引用次数: 0

摘要

处理泄殖腔外营养不良新生儿的传统方法通常包括将盲肠板从两个半膀胱之间分离出来,将其管化以纳入粪便流,建立末端结肠造口,并将两个半膀胱合并在一起。本研究介绍了另一种方法,即把盲肠板保留在原来的位置,并指定将来用作膀胱的自动附件。本研究描述了 2019 年 11 月至 2024 年 2 月间处理的四例泄殖腔外营养病例,并报告了手术方法和术后结果。接受传统重建术的两名患者因盲肠板淤积而导致细菌过度生长,表现为造口输出量增加和喂养不耐受。这两个病例的治疗方法是将盲肠从粪流中移除,并将其用作膀胱扩容器。吸取了这些病例的教训,第三和第四个新生儿的治疗方法是在原位保留盲肠,用于膀胱的自动增容,并进行回肠与后肠的吻合。这些患者均未发生术后酸中毒。对泄殖腔外翻的新生儿采取另一种治疗方法,即在原位保留盲肠板,可以减少瘀血和术后细菌过度生长。这种方法可以实现膀胱的自动增容,在技术上比传统的从两个半膀胱内抢救盲肠板更容易。
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A Modification of the Newborn Operation for Cloacal Exstrophy: Leaving the Cecal Plate Untouched.

The conventional approach to managing a newborn with cloacal exstrophy typically includes separating the cecal plate from between the two hemibladders, tubularizing it to be included in the fecal stream, creating an end colostomy, and bringing the two bladder halves together. This study introduces an alternative approach wherein the cecal plate is retained in its original position and designated for future use as an autoaugment of the bladder. Four cases of cloacal exstrophy cases managed between November 2019 and February 2024 are described, with surgical approach and postoperative outcomes reported. Two patients who underwent traditional reconstruction experienced bacterial overgrowth attributed to stasis in the cecal plate, which manifested in increased ostomy output and feeding intolerance. Treatment in these two cases was to remove the cecum from the fecal stream and use it instead for a bladder augment. Learning from these cases, the third and fourth newborn's approach involved retaining the cecum in situ for autoaugmentation of the bladder and performing an ileal to hindgut anastomosis. No postoperative acidosis occurred in these patients. The alternative approach to the newborn management of cloacal exstrophy whereby the cecal plate is left in situ can decrease stasis and postoperative bacterial overgrowth. It allows for an autoaugmentation of the bladder and is technically easier than the traditional rescue of the cecal plate from within the two hemibladders.

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