Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector103110.17816/psaic1031Original Study ArticlesОригинальные исследованияResearch ArticleDelayed surgical treatment of children with exstrophy without approximation of the pubic bones, the use of displaced flaps and immobilization of the patientОтсроченное хирургическое лечение детей с экстрофией без аппроксимации лонных костей, использования перемещенных лоскутов и иммобилизации пациентаhttps://orcid.org/0000-0001-7815-4825NikolaevVasily V.НиколаевВасилий Викторович
Russian Federation

Dr. Sci. (Med.), Professor

д-р мед. наук, профессор

vasnik@yandex.ruhttps://orcid.org/0000-0001-7508-50192757-6028DeminNikita V.ДеминНикита Валерьевич
Russian Federation

Cand. Sci. (Med.), Leading Researcher

канд. мед. наук, ст. н. с.

doctor@drdemin.ruhttps://orcid.org/0000-0002-9916-419XLadyginaElizaveta A.ЛадыгинаЕлизавета Александровна
Russian Federation

Postgraduate student

аспирант

doc.lizaladygina@yandex.ruPirogov Russian National Research Medical UniversityРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаClinical and Research Institute of Emergency Pediatric Surgery and TraumaНаучно-исследовательский институт неотложной детской хирургии и травматологииPeoples’ Friendship University of RussiaРоссийский университет дружбы народов181220211144454541211202101122021Copyright ©; 2021, Nikolaev V.V., Demin N.V., Ladygina E.A.Copyright ©; 2021, Николаев В.В., Демин Н.В., Ладыгина Е.А.2021Nikolaev V.V., Demin N.V., Ladygina E.A.Николаев В.В., Демин Н.В., Ладыгина Е.А.https://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/1031

BACKGROUND: Bladder exstrophy is one of the most difficult for the reconstruction of malformations.

AIM: This study aimed to evaluate the outcomes of delayed bladder closure in exstrophy in comparison with procedures in newborns and to test the hypothesis that the reliability of bladder closure does not decrease without closing the fascial defect between the rectus abdominis muscles and that the postoperative period is more favorable.

MATERIALS AND METHODS: Delayed closure of exstrophy without osteotomy, convergence of pubic bones, or flap movement was performed in 46 patients with classic bladder exstrophy. Among them, 34 were primary patients, and the remaining patients, who had a complete relapse of exstrophy as a result of suture divergence, had undergone unsuccessful surgery in other clinics 1–4 times (n = 12). In total, 25 were boys and 21 were girls who underwent surgery from 2006 to 2021.

RESULTS: Delayed bladder closure was successful in all 46 children (100%). No signs of acute pain were noted. Serious complications such as dehiscence of the sutures in the bladder and proximal urethra were not observed. Minor complications occurred in five patients, which resolved promptly.

DISCUSSION: In the treatment of exstrophy, successful primary bladder closure is critical to achieving future urinary continence. The elimination of the defect between the rectus abdominis muscles with the convergence of the pubic bones has significant drawbacks, including an increase in the operating time and trauma, need for blood transfusion, risk of orthopedic and neurological complications, and a more difficult postoperative period. The vast majority of the patients develop rediastasis. The authors proposed a more reliable method of delayed closure of exstrophy.

CONCLUSIONS: The presented method of bladder closure was 100% successful. The procedure was simplified technically, the surgery time was reduced, and the postoperative period proceeded more easily without prolonged pain syndrome, prolonged use of analgesics, and, in most cases, without blood transfusions.

Введение. Экстрофия мочевого пузыря — один из сложнейших для реконструкции пороков развития.

Цель — оценка результатов применения методики отсроченного закрытия мочевого пузыря при экстрофии в сравнении с операциями у новорожденных и проверка гипотезы о том, что надежность закрытия мочевого пузыря не снижается без закрытия фасциального дефекта между прямыми мышцами живота, а послеоперационный период при этом протекает более благоприятно.

Материалы и методы. Операции отсроченного закрытия экстрофии без остеотомии, сближения лобковых костей или перемещения лоскутов выполнены у 46 пациентов с классической экстрофией мочевого пузыря. Среди них было 34 первичных пациента, а остальные — с полным рецидивом экстрофии в результате расхождения швов, которые ранее были неудачно оперированы в других клиниках от 1 до 4 раз (n = 12). В исследовании приняли участие 25 мальчиков и 21 девочка, прооперированные в период с 2006 по 2021 г.

Результаты. Отсроченное закрытие мочевого пузыря было успешным у всех 46 детей (100 %). Признаков острой боли не отмечалось. Не отмечено таких серьезных осложнений, как расхождение швов мочевого пузыря и проксимальной уретры. Малые осложнения возникли у 5 пациентов, которые были устранены в короткие сроки.

Обсуждение. При лечении экстрофии решающее значение для достижения удержания мочи в будущем играет успешное первичное закрытие мочевого пузыря. У методики с устранением дефекта между прямыми мышцами живота со сближением лонных костей есть существенные недостатки, такие как увеличение операционного времени, травмы, необходимость переливания крови, риск ортопедических и неврологических осложнений, более тяжелый послеоперационный период. У подавляющего большинства пациентов наступает редиастаз. В настоящей работе предложен более надежный метод отсроченного закрытия экстрофии.

Заключение. Представленная методика закрытия мочевого пузыря позволила добиться 100 % успешных результатов. Операция упростилась технически, сократилась по продолжительности, а послеоперационный период протекает более легко: без длительного болевого синдрома, пролонгированного применения анальгетиков и в большинстве случаев без переливаний крови.

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