一期Duckett与分期Bracka尿道成形术治疗非远端型尿道下裂术后并发症的Meta分析  

Efficacy of one-stage Duckett versus staged Bracka urethroplasty for nondistal hypospadias:a meta-analysis

作　　者：杨珍珍 李佳义 刘沛 宋宏程[1] 张潍平[1] Yang Zhenzhen;Li Jiayi;Liu Pei;Song Hongcheng;Zhang Weiping(Department of Urology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院泌尿外科,北京100045

出　　处：《临床小儿外科杂志》2023年第2期168-179,共12页Journal of Clinical Pediatric Surgery

摘　　要：目的评价并比较一期Duckett与分期Bracka尿道成形术治疗非远端型尿道下裂的临床疗效。方法检索PubMed、Embase、Web of science、Cochrane图书馆、中国知网、万方和维普数据库中关于一期Duckett与分期Bracka尿道成形术治疗非远端型尿道下裂的随机或非随机对照试验、队列研究和病例对照研究,检索文献时限为数据库建库至2022年3月28日。结局指标包括术后总体并发症和独立并发症(尿道瘘、尿道狭窄、尿道憩室、伤口裂开及移植物相关并发症)情况及手术次数。应用RevMan 5.4进行Meta分析。结果本研究共纳入41篇文献共3713例患儿,其中2395例接受一期Duckett尿道成形术,1318例接受分期Bracka尿道成形术。Meta分析结果显示,一期Duckett尿道成形术较分期Bracka尿道成形术,术后尿道瘘(RD=0.17和RD=0.10,P<0.05)、尿道狭窄(RD=0.10与RD=0.03,P<0.05)及尿道憩室(RD=0.04与RD=0.02,P<0.05)的发生率均更高,差异均有统计学意义。5篇关于两种术式对比研究的Meta分析结果显示,一期Duckett尿道成形术后总并发症发生率高于分期Brack尿道成形术(OR=2.63,95%CI:1.54~4.50,P<0.05)。一期Duckett尿道成形术与分期Bracka尿道成形术平均手术次数分别为1.29次和2.15次。结论一期Duckett尿道成形术后并发症总发生率,尿道瘘、尿道狭窄及尿道憩室发生率高于分期Bracka尿道成形术;分期Bracka尿道成形术后移植物相关并发症发生率为5%。一期Duckett尿道成形术治愈非远端型尿道下裂所需手术次数更少。Objective To review the currently available data and evaluate the efficacy of one-stage Duckett versus staged Bracka urethroplasty for non-distal hypospadias through Meta-analysis.Methods The database of PubMed,Embase,Web of Science,Cochrane Library,CNKI,Wanfang and VIP were searched for randomized or non-randomized controlled trials,cohort studies and case-control studies of one-stage Duckett versus staged Bracka urethroplasty for non-distal hypospadias.The measurement parameters included overall postoperative complications and individual complications(urethral fistula,urethral stricture,urethral diverticulum,wound dehiscence&graft-related complications).Meta-analysis was performed with RevMan 5.4 software.Results A total of 3713 children were collected from 41 articles examining the effectiveness of one-stage Duckett urethroplasty(n=2395)versus staged Bracka urethroplasty(n=1318)were included for Meta-analysis.Meta-analysis results indicated that marked inter-group differences existed in occurrence rate of postoperative urethral fistula(RD=0.17 and RD=0.10,P<0.05),occurrence rate of urethral stricture(RD=0.10 and RD=0.03,P<0.05),occurrence rate of diverticula(RD=0.04 and RD=0.02,P<0.05)and occurrence rate of postoperative wound dehiscence(RD=0.02 and RD=0.04,P<0.05).Meta-analysis results of 5 comparative studies showed that total complication rate after one-stage Duckett urethroplasty was higher than that of staged Brack(OR=2.63,95%CI:1.54-4.50,P<0.05).Operative frequency of one-stage Duckett urethroplasty and staged bracka urethroplasty were 1.29 and 2.15 respectively.Conclusion The occurrence rate of total complications,urethral fistula,urethral stricture and urethral diverticulum after one-stage Duckett urethroplasty was higher than that of staged Bracka.Graft-related complication rate after staged Bracka urethroplasty is 5%.One-stage Duckett urethroplasty for non-distal hypospadias requires fewer operations.

关 键 词：尿道下裂 外科手术 手术后并发症 META分析 

分 类 号：R726.9[医药卫生—儿科]