未成年患者尿道下裂术后阴茎外观满意度和社会精神心理的随访研究  

Penile appearance, social adaptation and psychological condition of children and adolescents who underwent hypospadias： a follow-up study

作　　者：李茂仙[1] 杨越[1] 杨屹[1] 侯英[1] 陈辉[1] Li Maoxian Yang Ywe Yang Yi Hou Ying Chen Hui.(Department of Pediatric Urology Surgery, ShengJing Hospital, China Medical University, Shenyang 110004, China)

机构地区：[1]中国医科大学附属盛京医院小儿泌尿外科,沈阳110004

出　　处：《中华泌尿外科杂志》2016年第11期841-845,共5页Chinese Journal of Urology

摘　　要：目的 探讨尿道下裂术后未成年患者对阴茎外观的满意度及其社会精神心理状况.方法 回顾性分析2003年1月至2013年1月收治的85例尿道下裂术后未成年患者的病例资料.尿道下裂分型：远端型50例,近端型35例.27例（31.8％）术后出现并发症.85例随访时平均年龄为（9.9±3.1）岁,平均随访时间（6.4±3.1）年.通过门诊复诊完成基本情况调查表、小儿阴茎感知评分量表（pediatric penile perception score,PPPS）和儿童行为量表（child behavior checklist,CBCL）,分析患者对尿道下裂术后阴茎外观的满意度及相关精神心理问题.结果 本组85例中,66例（77.6％）对术后阴茎外观满意,术后出现并发症及手术次数与患者希望再次手术改善阴茎外观呈正相关（r=0.442;r=0.529,P＜0.05）.PPPS结果提示患者、患者父母及泌尿外科医生对尿道下裂术后阴茎外观的满意评分分别为1.97±0.41、1.53±0.42、1.68±0.26,患者自我评分明显高于父母及泌尿外科医生（P＜0.05）.48例（65.9％）患者存在不同程度的社会精神心理问题,阴茎外观负面评估越重（r =0.373,P＜0.01）、阴茎外观满意度越低（r=-0.330,P＜0.01）、尿道下裂类型越重（r=0.252,P＜0.01）,患者出现社会精神心理问题的可能性越大.患者对尿道下裂知识了解程度与出现精神心理问题之间呈负相关（r=-0.515,P＜0.01）.CBCL提示尿道下裂患者社交情况和学习能力无明显异常,患者父母学历、尿道下裂类型和手术方式等与患者行为问题阳性因子发生率无明显相关性（P＞0.05）.结论 未成年患者尿道下裂术后的社交和学习能力基本正常.尿道下裂的类型、手术次数、有无并发症、尿道下裂术后阴茎外观是影响尿道下裂术后未成年患者疗效评估的重要因素.Objective To evaluate the outcomes of hypospadias surgery relating to penile appearance,social adaptation and psychological condition in children and adolescents.Methods 85 patients who underwent urethroplasty （2003-2013） in our department,hypospadias was distal and proximal in 50 and 35 patients;27 of them with complications.All of patients were interviewed by a urologist in our department with self-designed questionnaire,Achenlach Child Behavior Checklist （CBCL） and Pediatric Penile Perception Score（PPPS）.Mean age was 9.97 years and median follow-up of 6.4 years.Results 67 （77.0％） patients were satisfied with their penile appearance.Patients with complications or more surgical times were more likely to improve the appearance by operation again.The PPPS data showed that patients themselves were most satisfied with the appearance of the genitals than the parents of boys or the urologists.Patients with poor genital self-perception,lower satisfaction of their penile appearance or severer types of hypospadias,they were more likely to suffer from psychosocial problems（P ＜ 0.05）.The higher knowledge of hypospadias predicted the more positive penile self-perception,and the better follow-up rate（P ＜ 0.05）.CBCL survey data revealed that some patients had few hobbies,while their social situation and learning ability were normal.Conclusions Boys with corrected hypospadias appeared to experience normal social and learning ability.The type of hypospadias,surgical times,complications and the penile appearance were important factors in assessing the outcome of hypospadias.

关 键 词：尿道下裂 外观 心理 随访研究 

分 类 号：R726.9[医药卫生—儿科]