目的:在本研究中,我们对成人经典膀胱外翻(CBE)伴腹壁缺失的病例进行了回顾性分析.具体来说,我们专注于利用多层皮瓣进行重建。此外,我们旨在分享我们与类似挑战相关的临床治疗经验,从而提供有价值的见解,以补充这种罕见疾病的手术管理。
方法:我们对2013年6月至2020年1月期间接受初始治疗的12例被诊断为CBE的成年患者进行了回顾性分析。所有患者均接受多层重建以解决其腹壁缺陷。这涉及利用源自腹部浅筋膜的浅皮瓣,并结合了由腹直肌前鞘和外斜肌腱膜组成的肌筋膜皮瓣。皮瓣尺寸范围为9×11cm至13×15cm。
结果:12例CBE患者的腹壁重建导致伤口裂开无复发,尿路梗阻,或者尿路感染.根据自我评估,所有患者对腹壁的美学结果表示满意。他们报告说,在没有任何限制的情况下,成功地恢复正常的生活和工作活动。已婚患者对他们的性功能表示满意。
结论:在患有先天性CBE的成人中使用涉及多个皮瓣的多层重建技术可以成功地恢复泌尿功能,以及达到足够的腹壁强度来支持日常生活和工作活动,同时保持性功能。然而,由于这种情况罕见且缺乏客观的评估措施,因此谨慎评估手术结局非常重要.
OBJECTIVE: In this study, we conducted a retrospective analysis of cases involving adult classic bladder exstrophy (CBE) accompanied by the absence of the abdominal wall. Specifically, we focused on the utilization of multilayer flaps for reconstructive purposes. In addition, we aimed to share our clinical treatment experience pertaining to similar challenges, thereby providing valuable insights to complement the surgical management of this rare disease.
METHODS: We conducted a retrospective analysis of 12 adult patients diagnosed with CBE who underwent initial treatment between June 2013 and January 2020. All patients underwent multilayer reconstruction to address their abdominal wall defects. This involved utilizing shallow flaps derived from the superficial fascia of the abdomen and incorporating myofascial flaps composed of the anterior sheath of the rectus abdominis and aponeurosis of the external oblique muscle. The flap sizes ranged from 9 × 11 cm to 13 × 15 cm.
RESULTS: Abdominal wall reconstruction in the 12 patients with CBE resulted in an absence of wound dehiscence recurrence, urinary obstruction, or urinary tract infection. All patients expressed satisfaction with the aesthetic outcome of their abdominal wall based on self-evaluation. They reported a successful resumption of normal life and work activities without experiencing any restrictions. The married patients expressed contentment with their sexual function.
CONCLUSIONS: The utilization of a multilayered reconstruction technique involving multiple flaps in adults with congenital CBE allows for successful restoration of urinary function, as well as the attainment of sufficient abdominal wall strength to support daily life and work activities, while preserving sexual function. However, it is important to approach the evaluation of surgical outcomes with caution because of the rarity of this condition and the lack of objective assessment measures.