分叉尿道海绵体修复在尿道下裂Duckett术中的应用研究  

Application of branchedspongiosum repair in duckett surgery for hypospadias

作　　者：余玲[1] 包杰文 陈艳[1] 孙会振 吕逸清[1] 李晓溪[1] 孙莉[1] 谢华[1] 陈方 黄轶晨[1] Yu Ling;Bao Jiewen;Chen Yan;Sun Huizhen;Lyu Yiqing;Li Xiaoxi;Sun Li;Xie Hua;Chen Fang;Huang Yichen(Department of Urology,Shanghai Children’s Hospital,Shanghai Jiao Tong University,Shanghai 200062,China;Department of Urology,Shanghai Jiao Tong University Affiliated Sixth People’s Hospital,Shanghai 200233,China)

机构地区：[1]上海市儿童医院泌尿外科,200062 [2]上海交通大学附属第六人民医院泌尿外科,200233

出　　处：《中华泌尿外科杂志》2019年第11期816-820,共5页Chinese Journal of Urology

摘　　要：目的探讨分叉尿道海绵体修复技术降低尿道下裂Duckett术术后并发症发生率的效果。方法回顾性分析2016年1月至2018年4月上海市儿童医院收治的140例尿道下裂患儿的临床资料。术前常规检查均无异常,体重均>10 kg。患儿均全麻下行Duckett尿道成形术,阴茎头贯穿牵引,测量冠状沟直径为初始值。根据新成形尿道表面覆盖物将患儿分为2组。试验组68例,年龄(1.8±1.1)岁;术前测量冠状沟直径为0.8(0.7,1.0)cm;术中人工勃起后测量阴茎弯曲度(50±20)°,术中测量尿道缺损长度(3.5±1.0)cm;术中将尿道板两侧发育不良的、分叉的尿道海绵体及其外侧Buck’s筋膜自阴茎白膜表面裁剪至冠状沟,尿道成形后再缝合覆盖于新成形尿道表面。对照组72例,年龄(1.8±1.7)岁;术前测量冠状沟直径为0.9(0.7,0.9)cm;术中测量阴茎弯曲度(50±20)°,尿道缺损长度(3.5±1.0)cm;术中采用Dartos筋膜或皮下筋膜覆盖新成形尿道表面。两组的年龄(P=0.451)、阴茎弯曲度(P=0.795)、尿道缺损长度(P=0.431)差异无统计学意义。术后以6号或8号胃管作为尿道支撑管引流尿液2周。比较两组的手术时间、术后冠状沟直径增加值、术后6个月尿流率最大值和并发症发生率。术后发生尿瘘、尿道狭窄及尿道裂开定义为手术失败。结果两组手术均顺利完成。试验组和对照组的手术时间分别为(135±49)min与(135±45)min(P=0.580)、术后冠状沟直径增加值分别为(0.1±0.2)cm与(0.1±0.1)cm,(P=0.167),差异均无统计学意义。术后随访12个月,试验组8例(11.8%)发生尿道皮肤瘘,其中冠状沟瘘3例(4.4%),6例(8.8%)发生尿道狭窄,无尿道裂开病例;对照组18例(25.0%)发生尿道皮肤瘘,其中冠状沟瘘11例(15.3%),10例(13.9%)发生尿道狭窄,2例(2.8%)发生尿道裂开。两组的总并发症发生率及术后尿瘘(主要是冠状沟瘘)发生率差异均有统计学意义(P<0.05),尿道狭窄发生率差异无统计学意义(Objective To explore the effect of reducing complication in branched spongiosum repair for hypospadias Duckett surgery.Methods Retrospective analysis was performed for the clinical data of 140 surgical infants with hypospadias Duckett surgery from January 2016 to April 2018.According to different covering materials on newly formed urethra,the experimental group(68 cases)cut dysplasia,branched spongiosum and lateral Buck′s fascia from tunica albuginea to coronary groove and then sutured over newly formed urethra,and the control group(72 cases)used Dartos fascia or subcutaneous fascia.The operative age,penile curvature,length of urethral defect,operation time,added value of coronary groove before and after operation,maximum urinary flow rate and complication rate of postoperative follow-up were compared between the two groups,and the therapeutic effect was analyzed.Results There was no statistically significant difference between two groups in operating time[(135±49)min vs.(135±45)min,P=0.580]and the value added of coronary sulcus[(0.1±0.2)cm vs.(0.1±0.1)cm,P=0.167].In experimental group,there were 8 cases of urethra percutaneous fistula(11.8%)(coronary groove fistula in 3 cases,4.4%)and 6 cases of urethral stenosis(8.8%)without urethral dehiscence.In control group,there were 18 cases of urethra percutaneous fistula(25.0%)(coronary groove fistula in 11 cases,15.3%),10 cases of urethral stenosis(13.9%),and 2 cases of urethral dehiscence(2.8%).The incidence of postoperative urinary fistula and total complications in experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05),while the incidence of urethral stenosis was not statistically different between two groups(P>0.05).The maximum urine flow rate of experimental group at 6 months after surgery was significantly higher than control group[(9.5±3.8)ml/s vs.(6.8±2.8)ml/s],and the difference was statistically significant(P<0.001).Conclusions Urethral cavernosum reconstruction can significantly reduce the

关 键 词：尿道下裂 DUCKETT术 尿流率 随访 

分 类 号：R69[医药卫生—泌尿科学]