先天性膀胱外翻腹壁缺损的整形外科修复

Application of means of plastic surgery in repairing the abdominal defect of congenital bladder exstrophy

目的:探讨修复先天性膀胱外翻腹壁缺损的常用整形外科方法及适应证选择。方法:2004年6月-2014年6月,利用整形外科原则分析先天性完全性膀胱外翻的腹壁组织缺损范围和程度,分别应用腹壁局部肌筋膜瓣、阔筋膜张肌皮瓣、阴股沟皮瓣及髂腹股沟皮瓣修复先天性完全性膀胱外翻腹壁缺损患者共18例,男13例,女5例,首次手术者14例,曾接受过失败的修复手术者4例,患者年龄1岁2个月~34岁,平均年龄14.6岁。皮瓣面积:4cm×3cm^10cm×10cm。结果:15例患者腹壁缺损一期愈合,修复效果满意,皮瓣成活良好,3例采用带蒂阔筋膜张肌肌皮瓣修复者出现皮瓣部分坏死或愈合不良,其中2例经游离植皮后痊愈,1例表皮坏死通过换药后愈合。本组18例患者平均随访36个月(6~72个月),全部患者外翻的膀胱得到还纳,腹壁缺损得以修复,腹部外形和排尿功能恢复较为满意。结论:针对不同年龄和腹壁缺损程度的患者,选择性使用整形外科皮瓣尽早闭合完全性膀胱外翻腹壁缺损,效果肯定,术后形态满意,在一定程度上恢复了患者自主排尿功能,提高了患者的生活质量。

Objective To sum up reconstructive options for the treatment of abdominal defect of classic bladder exstrophy（CEB）,and to evaluate the clinical efficacy and feasibility of these options. Methods From June 2004 to June 2014,18 cases with abdominal defect of CEB were treated （13 males and 5 females,mean age 14.6y） with four plastic surgery flaps such as local myo-fascial flap （5 cases）,the tensor lata musculocutaneous flap（6 cases）,the pudendo-inguinal flap（2 cases） and the groin flap（5 cases）. In this series,14 cases had untreated CEB,other 4 had pubic epispadias after failed neonatal bladder closure.The maximal size of the flap was 10×10cm. Results 15 cases were primary cured and obtained functional and cosmetic improvement.3 cases treated with the tensor lata musculocutaneous flap were partly necrosis,while the debridement was needed, and the wound was covered by skin graft or dressing change.During 6 to 72 months followed-up, all patients healed well without complications and recidivation. Conclusion Selective use of plastic surgery flap as early as possible was crucial to repair abdominal wall defects in CEB.Adequate cosmetic appearance and improvement of voiding function could be obtained for these patients.