阴茎头宽度和尿道板宽度对尿道下裂TIP手术后并发症的影响分析  

Impacts of glanular width and urethral plate width on tubularized incised plate urethroplasty complications in children with hypospadias

作　　者：杨志林[1] 张培良 何盈颖 柯志聪 尹鉴淳[1] 李家强 孙丰浩 李守林[1] Yang Zhilin;Zhang Peiliang;He Yingying;Ke Zhicong;Yin Jianchun;Li Jiaqiang;Sun Fenghao;Li Shoulin(Department of Urology and Laboratory of Pelvic Floor Muscle Function,Municipal Children's Hospital,Shenzhen 518038,China;Shenzhen Pediatric Clinical Pediatric College,Shantou University,Shenzhen 518038,China;Shenzhen Children's Hospital,China Medical University,Shenzhen 518038,China)

机构地区：[1]深圳市儿童医院泌尿外科和盆底肌功能实验室,深圳518038 [2]汕头大学医学院深圳儿科临床学院,深圳518038 [3]中国医科大学深圳市儿童医院,深圳518038

出　　处：《临床小儿外科杂志》2024年第6期555-560,共6页Journal of Clinical Pediatric Surgery

基　　金：广东省高水平医院建设专项经费资助(2020-2024);深圳市医学重点学科(SZXK035)

摘　　要：目的探讨尿道下裂尿道板纵切卷管尿道成形(tubularized incised plate urethroplasty,TIP)手术后并发症的影响因素。方法本研究为回顾性研究,以2019年1月至2021年6月深圳市儿童医院泌尿外科同一治疗组收治的接受TIP手术的尿道下裂患儿作为研究对象,根据是否出现并发症将患儿分为并发症组和无并发症组,收集两组患儿手术年龄、尿道口位置、尿道板宽度、阴茎头宽度、尿道缺损长度、手术时间以及术后并发症情况(包括尿道瘘、尿道狭窄、龟头裂开等),采取二元Logistic回归分析TIP手术后并发症的影响因素。结果本研究共纳入尿道下裂患儿275例,平均年龄3.7岁(1.0~16.0岁);阴茎头宽度≥13 mm者240例,<13 mm者35例;尿道板宽度<8 mm者224例,≥8 mm者51例。275例均获随访,随访时间1~3年,其中17例(17/275,6.2%)术后出现并发症,包括尿道瘘12例、尿道狭窄2例、龟头裂开4例(其中1例同时合并尿道瘘和尿道狭窄)。尿道板宽度≥8 mm组与尿道板宽度<8 mm组并发症发生率差异无统计学意义[(2/51,3.9%)比(15/24,6.7%),P=0.448]。阴茎头宽度≥13 mm组较阴茎头宽度<13 mm组并发症发生率低,差异有统计学意义[(3.8%,9/240)比(8/35,22.9%),P=0.001]。单因素Logistic回归分析结果显示,术后并发症的影响因素包括尿道外口位置、阴茎头宽度、尿道缺损长度以及手术时间(P<0.05);多因素Logistic回归分析结果显示,TIP手术后并发症的独立影响因素为阴茎头宽度(OR=0.624,95%CI:0.423~0.920,P=0.017),尿道板宽度与TIP手术后并发症无关(P>0.05)。结论阴茎头宽度可影响尿道下裂TIP手术后并发症的发生率,对于阴茎头宽度<13 mm的尿道下裂,需要慎重考虑行TIP手术;临床可不必根据尿道板宽度来决定是否行TIP手术。Objective To explore the impact factors of tubularized incised plate(TIP)urethroplasty complications Methods From January 2019 to June 2021,prospective review was conducted for 272 children with hypospadias undergoing TIP urethroplasty.Operative age,meatus location,urethral plate width,glans width,urethral defect,operative duration and postoperative complications of urethral fistula,urethral stricture and glanular dehiscence were recorded.They were assigned into two groups of complication and normal.Multi-factorial Logistic regression analysis was performed for examining the correlation of observation factors and postoperative complications.Results Mean age was 3.7(1-16)year.Glanular width was≥13 mm(n=240)and<13 mm(n=35).Urethral width was<8 mm(n=224)and≥8 mm(n=51).During a follow-up period of(1-3)year,17 children(6.2%)developed urethral complications of urethral fistulas(n=12),urethral stricture(n=2)and glanular dehiscence(n=4).No significant difference existed between children with urethral plate≥8 mm and<8 mm[2/51(3.9%)vs.15/24(6.7%),P=0.448].Complication rate was lower in children with glanular width≥13 mm than those with glanular width<13 mm[3.8%(9/240)vs.8/35(22.9%),P=0.001].Univariate Logistic regression indicated that meatus location,glanular width,urethral defect and operative duration were potential impact factors.However,multiple Logistic regression revealed that glanular width was the only impact factor of postoperative complications.Conclusions Glanular width is a risk factor of postoperative complications after TIP urethroplasty.For glanular width under 13 mm,TIP repair is recommended without a consideration of urethral plate width.

关 键 词：尿道下裂 外科手术 阴茎 尿道 手术后并发症 影响因素分析 

分 类 号：R726.9[医药卫生—儿科]