腹侧延长术和背侧折叠术治疗近端型尿道下裂的疗效对比  

Efficacies of ventral lengthening versus dorsal plication for severe ventral curvature during proximal hypospadias repair.

作　　者：吴少峰[1] 何蓉[1] 孙杰[1] 赵海腾[1] Wu Shaofeng;He Rong;Sun Jie;Zhao Haiteng(Department of Urology,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心泌尿外科,上海市200127

出　　处：《临床小儿外科杂志》2020年第7期603-607,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金青年基金资助项目(编号:81100477);上海市自然科学基金资助项目(编号:11ZR1423300)。

摘　　要：目的阴茎下弯的矫直是近端型尿道下裂治疗的重点和难点,本研究旨在对比腹侧延长和背侧折叠技术对重度尿道下裂的治疗效果。方法回顾性分析2010年1月至2015年12月于上海儿童医学中心治疗的224例近端型尿道下裂患儿资料,根据手术方式分为腹侧延长(ventral lengthening,VL)组63例,背侧折叠(dorsal plication,DP)组161例。比较两组脱套前后尿道开口位置、阴茎下弯纠正程度以及术前HCG使用情况等资料,同时比较两组横断尿道板以及手术方式的差异,统计两组阴茎下弯复发、尿道瘘,憩室等并发症和再手术情况,分析阴茎下弯复发的影响因素。结果DP组平均手术年龄约12.3个月(8~48个月),VL组平均手术年龄为11.5个月(10~62个月),平均随访时间分别为DP组:62.4个月(44~110个月),VL组:55.7个月(41~96个月)。从阴囊型、会阴型所占比例来看,DP组明显少于VL组(44.7%vs.61.9%,P=0.021);术前两组HCG注射的人数比例分别为:DP组16.8%(27/161)、VL组34.9%(22/63)。DP组和VL组横断尿道板的人数比例分别为32.3%(52/161)和100%(63/63)。DP组共出现并发症54例(33.5%),VL组共出现并发症26例(41.3%),差异无统计学意义(P>0.278);再次手术主要原因为尿道瘘;两组尿道憩室的发生人数分别为8例(4.97%)和4例(6.35%),术后DP组31例阴茎下弯复发,而VL组仅5例阴茎下弯复发(19.3%vs.7.9%,P=0.038)。结论根据目前的随访结果,对于多数尿道下裂,背侧折叠术可以取得良好的手术效果;对于严重下弯的近端型尿道下裂,腹侧延长可有效改善阴茎下弯,减少阴茎弯曲的复发,但青春期后远期疗效仍需进一步观察。Objective Correcting severe ventral curvature is an essential step of proximal hypospadias repair.The goal was to compare the outcomes of ventral lengthening(VL)versus dorsal placation(DP)for severe curvature.Methods Retrospective analysis was conducted for 224 children with proximal hypospadias undergoing straightening curvature from January 2010 to December 2015 at a single institution.Based upon operative approaches,they were divided into two groups of VL(n=63)and DP(n=161).Meatal location,preoperative HCG stimulation,severe ventral curvature before and after degloving,urethral plate transection and staged operation were compared between two groups.The complications of recurrent curvature,urethral fistula,urethral diverticulum and reoperation were recorded.Univariate analysis was performed for assessing the association with recurrent curvature.Results The mean initial operative age was 12.3(8-48)months in DP group and 11.5(10-62)months in VL group.The mean follow-up period was 62.4(44-110)months in DP group and 55.7(41-96)months in VL group.For only scrotal/perineal hypospadias,the proportion in DP group was less that in VL group(72/161,44.7%vs 39/63,61.9%,P=0.021)and preoperative HCG stimulation was administered in a similar proportion between two groups(27/161 or 16.8%vs 22/63 or 34.9%,P=0.225).DP group underwent urethral plate transection while VL group had urethral plate transection(52/161,32.3%vs 63/63,100%).The overall complication requiring additional unplanned operations were compared(DP 54/33.5%vs VL 26/41.3%,P=0.278,including fistulas in 44/27.3%vs 20/31.7%,diverticula in 8/4.97%vs 4/6.35%).Univariate analysis revealed that use of dorsal plication was significantly associated with an elevated risk of recurrent curvature(19.3%vs 7.9%,P=0.038).Conclusion For short-term outcomes,dorsal plication for correcting ventral curvature is sufficient with excellent results.However,for proximal hypospadias with severe curvature,ventral lengthening is associated less frequently with recurrent curvature than dorsal

关 键 词：尿道下裂/外科学 治疗结果 对比研究 

分 类 号：R726.9[医药卫生—儿科] R699.8[医药卫生—临床医学]