女性膀胱外翻诊治2例报告并文献复习

Treatment of female bladder exstrophy:a report of 2 cases and literature review

目的报道2例女性膀胱外翻的诊治过程,提高对本病的认识。方法病例1为先天性成人膀胱外翻,采用膀胱壁瓣重建尿道;病例2为外伤导致下腹部广泛皮肤及皮下组织缺如,破裂的膀胱裸露并外翻于腹壁,关闭膀胱后,采用大腿内侧带蒂股薄肌肌皮瓣覆盖下腹部创面。结果病例1术后通畅排尿,且在术后6个月妊娠、生子,随访28个月,产后排尿、控尿均良好;病例2随访12个月,下腹部转移皮瓣成活,排尿状况良好。结论成年女性膀胱外翻患者,采用膀胱壁瓣重建尿道是一种可行的方法,可获得良好的控尿效果;带蒂股薄肌肌皮瓣可用于下腹部皮肤缺损的覆盖,创伤小、效果好。

Objective To report the treatment of 2 cases of female bladder exstrophy in order to raise the awareness of the disease, Methods Case 1 was congenital adult bladder exstrophy,and bladder wall flap was adopted to reconstruct the urethra. Case 2 was extensive absence of skin and subcutaneous tissue caused by trauma,which made the bladder exposed and exstrophied in the lower abdominal wall, Pedicled gracilis muscle flap was adopted to close the abdominal wall after the closure of the bladder. Results Case 1 achieved smooth voiding after treatment,conceived 6 months after the operation and gave birth to a full-term healthy boy,with normal urination during the follow-up of 28 months. Case 2 was followed up for 12 months, during which the transferred flap survived well and the urination was normal. CoNclusions For adult female patients with bladder exstrophy,bladder wall flap is viable for the reconstruction of neo urethra with good control of urination. Pedicled gracilis muscle flap can be used in the closure of lower abdominal wall defect with less trauma,