ObjectiveTo investigate the effectiveness of posterior sagittal anorectoplasty (PSARP) and total urogenital mobilization in treatment of cloacal malformation. MethodsThree girls with cloacal malformation were admitted between June 2010 and June 2013. The age was 2 years, 5 months, and 4 months, respectively. All patients received previous separated sigmoid colostomy. PSARP and total urogenital mobilization were performed to correct the malformation. Colostomy stoma was closed after confirming the patent of rectum and anus. Dilation of anus was sustained for 6 months after anorectoplasty. ResultsOperations were successfully completed in 3 cases. The durations of operation were 3 hours and 40 minutes, 4 hours and 20 minutes, and 3 hours and 50 minutes; the blood loss was 10, 20, and 10 mL; and the time of colostomy stoma closure was 3, 5, and 3 months, respectively. Three cases were followed up 13, 18, and 4 months, respectively; no anal stenosis or rectal prolapse occurred. They had normal micturition; the B ultrasonic examination showed that the residual urine volume was less than 10 mL. At 12 months after anorectoplasty, the Wexner scores were 1 and 5 in 2 cases followed up 13 and 18 months; according to Krickenbeck postoperative effect, 2 cases had defecation and no constipation; 1 case had soiling (grade 1). ConclusionPSARP and total urogenital mobilization should be the first choice in treatment of cloacal malformation with common channel less than 3 cm.
目的探讨哈乐预防腹部手术后尿潴留的临床价值。方法哈乐组于拔尿管前1 d开始用哈乐0.2 mg，1次/d，3～5 d； 对照组未予特殊药物治疗。比较2组的尿潴留发生率、尿路感染发生率、住院时间和副作用。结果哈乐组未发生尿潴留，对照组尿潴留发生率为28%，差异有统计学意义(P＜0.05)。哈乐组无一例发生尿路感染，对照组有5例（20%），2组间差异无统计学意义（Pgt;0.05）。哈乐组术后平均住院时间为（10.7±3.3） d，对照组为（11.6±3.0) d，2组间差异亦无统计学意义（Pgt;0.05）。 结论哈乐可明显减少尿潴留的发生率，是预防腹部手术后尿潴留的有效药物。
ObjectiveTo explore the effectiveness of thoracoscopic surgery for treating late-presenting congenital diaphragmatic hernias and summarize the experience. MethodsBetween October 2012 and February 2015, 21 children with late-presenting congenital diaphragmatic hernias underwent thoracoscopic surgery. Of the 21 cases, 12 were girls and 9 were boys with a median age of 1 year and 3 months (range, 2 months to 8 years). Eight patients had obvious symptom in the initial stage:shortness of breath and dyspnea; 13 cases were found occasionally through chest radiography. Of 21 cases, 17 had left diaphragmatic hernias and 4 had right diaphragmatic hernias. The emergency surgery was performed in 5 cases because oppressed obviously and selective operation in 16 cases. Hernial sac existed in 5 cases; there were 19 cases of Bochdalek's hernia and 2 cases of Morgagni's hernia. The size of diaphragmatic defect ranged from 3 cm×2 cm to 5 cm×5 cm. ResultsThe operation time was 35-80 minutes (mean, 50 minutes), and intraoperative blood loss was 3-5 mL (mean, 3.8 mL). Primary healing of incision was obtained. Postoperative abdominal distension and pneumothorax occurred in 12 and 2 cases respectively. The follow-up time was 1-3 years (mean, 20 months). All the cases had a good recovery and satisfactory appearance of the thoracic incision. The symptoms and signs of shortness of breath and dyspnea disappeared. There was no recurrence and chest infection. ConclusionUnder the conditions of mastering operative indications strictly, thoracoscopic repair for late-presenting congenital diaphragmatic hernia is safe and feasible. It can facilitate the procedure and decrease the recurrence rate relying on intraoperative application of hernia repair needle, knot pusher-assistant, and reasonable processing defect periphery.