endosergЭндокринная хирургияEndocrine Surgery2306-35132310-3965Типография «Печатных дел Мастер»10.14341/serg12707endoserg-12707Research ArticleКлиническая лекцияClinical lectureВыбор тактики феминизирующей пластики у девочек с врожденной дисфункцией коры надпочечниковThe choice of feminizing genitoplasty tactic in girls with congenital adrenal hyperplasyahttps://orcid.org/0000-0001-5656-1382АникиевАлександр ВячеславовичAnikievAlexander V.

К.м.н., врач детский хирург, eLibrary SPIN: 9880-7682, телефон: 8 (916) 510-16-43

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anikieal70@gmail.comНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation2020230820211443035Copyright © Аникиев А.В., 20212021Аникиев А.В.Anikiev A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surg-endojournals.ru/jour/article/view/12707

Выбор тактики феминизирующей пластики (одно- или двухэтапная) остается актуальным вопросом. Оперировать рано, в первые месяцы жизни ребенка, при достижении эндокринологической стабилизации, или отложить вмешательство до пубертата? Несмотря на большое количество подходов к хирургическому лечению, до сих пор не все результаты можно признать положительными. Есть осложнения, влияющие на качество жизни пациентов, не только хирургического, но и психологического характера. Преимущества того или иного подхода в настоящее время невозможно доказать, так как это потребует проведения проспективного мультицентрового мультидисциплинарного исследования отдаленных результатов при каждом из подходов. Поэтому детские хирурги еще длительное время в выборе тактики будут основываться на накопленном опыте и логических рассуждениях. Учитывая большой опыт междисциплинарной реабилитации, положительные отдаленные результаты, двухэтапная феминизация остается предпочтительной тактикой хирургического лечения девочек с врожденной дисфункцией коры надпочечников (ВДКН). Повышенный риск присоединения осложнений со стороны мочеполовой системы в виде инфекции мочеполовых путей, гематокольпоса и гематометры у девочек с узким общим мочеполовым каналом, который присущ вирилизации 3, 4 и 5-й степени по Прадеру, может быть рассмотрен как повод для проведения ранней одноэтапной феминизирующей пластики.

The choice of tactics for feminizing plastic surgery (one- or two-stage) remains an actually issue. To operate early, in the first months of a child’s life, when endocrinological stabilization is achieved, or to postpone the intervention until puberty? Despite the large number of approaches to surgical treatment, still not all results can be recognized as positive. There are complications that affect the quality of life of patients, not only of a surgical but also of a psychological nature. The advantages of one or another approach are currently impossible to prove, since this will require a prospective multicenter multidisciplinary study of long-term results with each of the approaches. Therefore, pediatric surgeons for a long time in the choice of tactics will be based on accumulated experience and logical reasoning. Given the extensive experience of multidisciplinary rehabilitation, the positive long-term results of two-stage feminization remains the preferred tactic for surgical treatment of girls with CAH. The increased risk of complications from the genitourinary system in the form of infections of the urinary tract, hematocolpos and hematometra in girls with a narrow common urogenital canal, which is inherent in virilization of 3, 4 and 5 degrees according to Prader, can be considered as a reason for an early one-stage feminizing plasty.

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The authors declare that there are no conflicts of interest present.