Primary Bladder Exstrophy Closure in Neonates: Challenging the Traditions
Primary Bladder Exstrophy Closure in Neonates: Challenging the Traditions
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DOI：
10.1016/j.juro.2013.07.020
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发表时间：
2014-01-01
影响因子：
6.6
通讯作者：
Cuckow, P.
中科院分区：
文献类型：
--
作者：
Mushtaq, I.;Garriboli, M.;Cuckow, P.
目的：我们描述了一种新的闭合新生儿膀胱外翻的方法，它挑战了术后固定和骨盆截骨术的作用。材料和方法：我们回顾了2007-2011年间我们机构对膀胱外翻的主要治疗。特别是，我们比较了外科病房中使用硬膜外镇痛的术后管理与重症监护病房中肌肉麻痹和机械通气的处理。临床结果衡量指标为完全进食时间、住院时间、术后并发症和再次闭合。还使用医院财务数据对成本效益进行了评估。数据以中位数(范围)表示。采用Fisher精确检验和非配对t检验进行统计学处理。结果：74例患者均一期闭合，未行截骨术。70例(95%)封堵成功。A组48例(65%)在病房管理，B组26例(35%)转至重症监护室。两组在胎龄(中位数39周，范围27至41周)和闭合年龄(3天，1至152天)方面是相同的。需要手术治疗的并发症A组4例(8.3%)，B组3例(11.5%)(P=0.609)。在病房接受管理的那组患者的住院时间显著缩短(11天比18天，p<；0.0001)。住进重症监护室的患者的中位费用为42,732美元，而直接住进外科病房的患者的中位费用为16,214美元(P<；0.0001)。结论：不需要下肢固定和截骨术的膀胱外翻一期闭合术是可行的。使用硬膜外镇痛的外科病房术后护理可缩短住院时间。
Purpose: We describe a novel approach to neonatal bladder exstrophy closure that challenges the role of postoperative immobilization and pelvic osteotomy.Materials and Methods: We reviewed the primary management of bladder exstrophy at our institutions between 2007 and 2011. In particular we compared postoperative management in the surgical ward using epidural analgesia to muscle paralysis and ventilation in the intensive care unit. Clinical outcome measures were time to full feed, length of stay, postoperative complications and redo closure. Cost-effectiveness was also evaluated using hospital financial data. Data are expressed as median (range). Significance was explored by Fisher exact test and unpaired t-test.Results: A total of 74 patients underwent primary closure without osteotomy. Successful closure was achieved in 70 patients (95%). A total of 48 cases (65%) were managed on the ward (group A) and 26 (35%) were transferred to the intensive care unit (group B). The 2 groups were homogeneous for gestational age (median 39 weeks, range 27 to 41) and age at closure (3 days, 1 to 152). Complications requiring surgical treatment were noted in 4 patients (8.3%) in group A and 3 (11.5%) in group B (p = 0.609). Length of stay was significantly shorter for the group managed on the ward (11 vs 18 days, p < 0.0001). Median costs were $42,732 for patients admitted to the intensive care unit and $16,214 for those admitted directly to the surgical ward (p < 0.0001).Conclusions: Primary closure of bladder exstrophy without lower limb immobilization and osteotomy is feasible. Postoperative care on the surgical ward using epidural analgesia results in shorter hospitalization.