阴茎头沟背侧局部减容术在尿道下裂保留尿道板修复手术中的应用  

Application of limited volume reduction of dorsal navicular fossa during repairing hypospadias with a preservation of urethral plate

作　　者：覃道锐[1] 王学军[1] 毛宇[1] 杨博 唐耘熳[1] Qin Daorui;Wang Xuejun;Mao Yu;Yang Bo;Tang Yunman(Department of Pediatric Surgery,Sichuan Academy of Medical Science,Sichuan Provincial People's hospital,Affiliated Hospital of Electronic Science&Technology University,Chengdu 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院,电子科技大学附属医院小儿外科,成都610072

出　　处：《临床小儿外科杂志》2022年第1期13-17,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金青年基金(82101666)。

摘　　要：目的介绍阴茎头沟背侧局部减容术在尿道下裂保留尿道板修复手术中的应用。方法以四川省人民医院于2019年1月至2021年4月在尿道下裂修复中采用阴茎头沟背侧局部减容术的64例患儿为研究对象,根据是否有尿道下裂手术史分为初治组和再手术组。收集患儿基本人口学资料,记录术前情况及术式,术后予门诊或网络随访;术后3~6个月于门诊检测自由尿流率,记录术后并发症;比较手术前后HOSE评分变化情况。结果所有患儿手术顺利,如期拔除尿管出院,术后尿道口呈纵裂外观,尿线呈水平抛物线。术后随访6~24个月,总并发症发生率为17.19%(11/64),其中初治组10.00%(2/20),再手术组20.45%(9/44),两组并发症发生率比较,差异无统计学意义(χ^(2)=0.450,P=0.50)。术后最大尿流率初治组为(9.49±1.74)mL/s,再手术组为(9.75±1.85)mL/s,两组差异无统计学意义(t=0.520,P=0.610)。初治组术后HOSE评分为(15.55±0.69)分,再手术组平均术前HOSE评分为(13.32±1.12)分,术后HOSE评分为(15.55±0.76)分。初治组与再手术组术后HOSE评分差异无统计学意义(t=-0.020,P=0.980),再手术组手术前后HOSE评分差异有统计学意义(t=-11.600,P<0.001)。结论阴茎头沟背侧局部减容术应用于尿道下裂修复安全、可行,可以改善尿道外口形态及尿流方向。Objective To explore the application and follow-up results of limited volume reduction of dorsal navicular fossa during repairing hypospadias with a preservation of urethral plate.Methods From January 2019 to April 2021,limited volume reduction of dorsal navicular fossa was employed for 64 hypospadiacs.Based upon an operative history or not,they were divided into two groups of initial treat and redo.Basic demographic profiles,preoperative status and surgical approaches were reviewed.Perioperative scores of hypospadias objective scoring evaluation(HOSE)for reoperated cases were recorded.Urodynamic study was performed at Month 3 post-operation.The incidence of complications was recorded.The perioperative changes of HOSE score were compared.Results All operations were successful.During a postoperative follow-up period of(6-24)months,the overall incidence of postoperative complications was 17.19%(10.00%in initial treat group versus 20.45%in redo group).There was no statistical difference(χ^(2)=0.450,P=0.500).Urethral orifice presented the postoperative appearance of longitudinal fissure and urinary line showed a horizontal parabola.Qmax of initial treat and redo groups was(9.49±1.74)and(9.75±1.85)ml/s.There was no statistical difference(t=0.520,P=0.610).And HOSE score of initial treat group was(15.55±0.69);the score of redo group was(13.32±1.12)pre-operation and(15.55±0.76)post-operation.There was no statistically significant difference(t=0.001,P=0.980).The pre/post-operation difference of HOSE score was statistically significant in redo group(t=-11.600,P<0.001).Conclusion Limited volume reduction of dorsal navicular fossa is both safe and feasible for hypospadiacs.And it may improve the morphology of external urethra and direction of urinary flow.

关 键 词：尿道下裂/外科学 修复外科手术 手术后并发症 治疗结果 

分 类 号：R726.9[医药卫生—儿科]