尿道下裂横裁带蒂包皮岛状皮瓣尿道成形术后近期并发症的危险因素分析  

Risk factors for short-term complications of hypospadias repair with transverse preputial island flap urethroplasty

作　　者：方一圩 宋宏程[1] 孙宁[1] 张潍平[1] 田军[1] 李明磊[1] 李宁[1] 屈彦超[1] 韩文文[1] 杨洋[1] 梁海燕[1] 王冠男[1] 李振武[1] Fang Yiwei;Song Hongcheng;Sun Ning;Zhang Weiping;Tian Jun;Li Minglei;Li Ning;Qu Yanchao;Han Wen-wen;Yang Yang;Liang Haiyan;Wang Guannan;Li Zhenwu(Department of Urology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院泌尿外科,北京100045

出　　处：《临床小儿外科杂志》2022年第1期18-23,共6页Journal of Clinical Pediatric Surgery

基　　金：北京市医院管理局儿科协同发展专项子课题(XTZD20180303)。

摘　　要：目的探讨尿道下裂横裁带蒂包皮岛状皮瓣尿道成形术(Duckett术式)后发生近期并发症的危险因素,以期提高尿道下裂的治疗效果。方法回顾性分析2018年12月至2019年12月首都医科大学附属北京儿童医院收治的首诊尿道下裂且手术方式为Duckett术式、分期Duckett术式或Duckett+Duplay术式患儿的临床资料以及近期随访结果,收集术后近期尿道瘘、尿道狭窄、尿道憩室等并发症情况。采用Logistic回归分析术后并发症的影响因素。结果符合病例纳入标准的患儿共220例,按实施手术方式的不同分为:Duckett术式组172例,Duckett+Duplay术式组20例,分期Duckett术式组28例。三组平均随访时间19个月,获随访208例,随访率94.5%。发生并发症103例(103/208,49.5%),其中尿道瘘58例(58/103,27.9%)、尿道狭窄29例(29/103,13.9%)、尿道憩室样扩张34例(34/103.16.3%)、阴茎下弯复发/残留3例(3/103,1.4%)。对Duckett术式组进行单因素分析发现,尿道缺损长度(P=0.048)、横裁带蒂包皮岛状皮瓣长度(P=0.034)、矫正阴茎下弯后尿道开口位置(P=0.027)是Duckett术式术后并发症的影响因素。而手术时年龄、阴茎长度、阴茎头长度及宽度、包皮形态、皮瓣平整度及弹性、包皮浅层血管分布与术后并发症无关(P>0.05)。多因素Logistic回归分析结果显示,尿道缺损长度(OR=1.858,95%CI:1.053~3.277)是Duckett术式术后并发症的独立影响因素(P=0.032)。结论重度尿道下裂手术治疗难度大,术后并发症发生率高。尿道缺损长度是Duckett术式发生并发症的重要影响因素。当尿道下裂患者阴茎条件差时,可行分期手术,以降低手术难度以及术后并发症发生率。Objective To explore the risk factors of postoperative complications of transverse preputial island flap urethroplasty(Duckett procedure),and to improve the treatment effect of hypospadias.Methods A retrospectively analysis was performed on the clinical and follow-up data of children with hypospadias undergoing operations of Duckett technique,staging Duckett technique or Duckett plus Duplay technique from December 2018 to December 2019.The information of short-term postoperative complications,including urethral fistula,urethral stricture and urethral diverticulum was collected.A multivariate analysis of risk factors for postoperative complications was performed.Results A total of 220 children were enrolled and divided into 3 groups:Duckett group(n=172),Duckett+Duplay group(n=20),and staging Duckett group(n=28).There are 208 cases who were followed up with the follow-up rate of 94.5%and mean follow-up time of 19 months.The complication rate was 49.5%(103/208),including 58 cases of urethral fistula(27.9%),29 cases of urethral stricture(13.9%),34 cases of urethral diverticulum dilation(16.3%),and 3 cases of recurrence/residual penile curvature(1.4%).Univariate analysis of Duckett group found that length of urethral defect(P=0.048),length of transverse preputial island flap(P=0.034),and location of urethral opening after correction of ventral curvature(P=0.027)were risk factors for postoperative complications of Duckett group.The patientsage,length of penis,length and width of penis head,shape of foreskin,flatness and elasticity of skin flap,and distribution of superficial blood vessels in foreskin were irrelevant to postoperative complications(P>0.05).Multivariate Logistic analysis showed that length of urethal defect(OR=1.858,95%CI:1.053~3.277)was an independent risk factor for postoperative complications after Duckett procedure(P=0.032).Conclusion Severe hypospadias entails difficult surgical treatment and high rate of postoperative complications.The length of urethral defect is an important factor influencing the

关 键 词：尿道下裂/外科学 包皮 外科皮瓣 手术后并发症 危险因素 治疗结果 随访研究 

分 类 号：R726.9[医药卫生—儿科]