尿道下裂术后患儿尿流动力学的研究  

A follow-up study on urodynamics of children after surgery for hypospadias

作　　者：石志康 蒋明珠 赵敏利 张俊杰[1] 张胜利[1] 李泸平[1] 范应中[1] Shi Zhikang;Jiang Mingzhu;Zhao Minli;Zhang Junjie;Zhang Shengli;Li Luping;Fan Yingzhong(Department of Pediatric Surgery,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院小儿外科,450052

出　　处：《中华小儿外科杂志》2020年第9期819-823,共5页Chinese Journal of Pediatric Surgery

基　　金：河南省医学科技攻关计划普通项目(201602055);河南省高等学校重点科研项目计划(18A320046)。

摘　　要：目的评估尿道下裂患儿术后远期排尿情况。方法面访和电话随访2001年11月至2013年11月间郑州大学第一附属医院小儿外科收治的尿道下裂术后5年以上且未满18岁的患儿,通过调查问卷和尿流动力学检查,对患儿排尿功能满意度和尿流动力学情况进行评估。结果共与158人取得了联系,获得完成全部问答的有效问卷63例,完成尿流动力学检查39例。患儿年龄6~18岁,平均10.8岁。根据尿道口位置进行分类,远段型20例(31.8%)、中段型31例(49.2%)、近段型12例(19%)。按尿道口到阴茎根部距离,将患儿分为远端型组(37例)和近端型组(26例)。排尿功能满意度调查中,85.7%(54/63)的患儿对排尿功能满意;另有14.3%(9/63)的患儿对排尿功能不满意,主要原因是尿线稍细、尿线不正及尿后滴沥。近端型组有26.9%(7/26)的患儿对排尿功能不满意者,高于远端型组的5.4%(2/37),组间比较,差异有统计学意义(P<0.05)。进行尿流动力学检查的患儿,依照尿道下裂严重程度等级分为远段型组(20例)、中段型组(31例)和近段型组(12例),三组最大尿流率分别为(19.68±8.08)ml/s、(14.91±3.92)ml/s和(6.01±0.71)ml/s,平均尿流率分别为(9.58±1.56)ml/s、(8.70±0.71)ml/s和(3.85±0.64)ml/s,排尿时间分别为(18.00±12.17)s、(28.29±11.60)s和(40.50±6.36)s,达峰时间分别为(8.70±4.91)s、(13.50±5.53)s和(18.50±3.54)s,残余尿量分别为(6.25±4.37)ml、(10.43±6.10)ml和(15.30±1.19)ml,最大逼尿肌收缩压分别为(27.50±13.03)cmH2O、(50.29±15.74)cmH2O和(96.50±35.86)cmH2O,上述指标组间比较,差异均有统计学意义(P均<0.05)。结论大部分尿道下裂患儿术后排尿功能良好,尿流动力学可以作为评价患儿排尿功能的一个客观指标。Objective To evaluate the postoperative long-term urination of children after surgery for hypospadias.Methods From November 2001 to November 2013,face-to-face interviews and telephone follow-ups were conducted among hospitalized children aged under 18 years after over 5 years after hypospadias surgery.The satisfaction extent with urine function and urine flow mechanics were evaluated through questionnaires and urine dynamic tests.Results A total of 158 children were contacted and 63 of them completed valid questionnaires while 39 received urodynamic examinations.The average age was 10.8(6-18)years.Based upon the location of urethral orifice,clinical types were distal(n=20,31.8%),middle(n=31,49.2%)and proximal(n=12,19%).Based upon the position of urethral opening,they were divided into distal(n=37)and proximal(n=26)groups.During a survey on the satisfaction of voiding function,85.7%(54/63)of them were satisfied with voiding function and 14.3%(9/63)were dissatisfied due to a weak steam,irregular lines and trickling.Through comparison,"proximal type group"had a higher proportion of dissatisfaction than that of"distal type group"(26.9%,7/26 vs.5.4%,2/37,P<0.05).Based upon the severity of hypospadias,children with urine dynamic test were divided into three groups of distal type(n=20),middle type(n=31)and proximal type(n=12).For three groups,maximal urinary flow rate was(19.68±8.08)ml/s,(14.91±3.92)ml/s,(6.01±0.71)ml/s,average urine flow rate(9.58±1.56)ml/s,(8.70±0.71)ml/s,(3.85±0.64)ml/s,flow time(18.00±12.17)s,(28.29±11.60)s,(40.50±6.36)s,time to maximal flow(8.70±4.91)s,(13.50±5.53)s,(18.50±3.54)s,residual volume(6.25±4.37)ml,(10.43±6.10)ml,(15.30±1.19)ml and maximal detrusor pressure(27.50±13.03),(50.29±15.74)and(96.50±35.86)cmH2O.And the differences between the above indices were statistically significant(P<0.05).Conclusions Most children have excellent voiding function after hypospadias surgery.And urodynamics may be performed as an objective index for evaluating urinary function of children.

关 键 词：尿道下裂 尿流动力学检查 问卷调查法 

分 类 号：R726.9[医药卫生—儿科]