尿道下裂初次矫治手术主要操作对阴茎长度的影响研究  

Effect of surgical steps in primary hypospadias repair on penile length

作　　者：唐耘熳 刘愉 王学军 毛宇 覃道锐 杨博 彭康洁 陈祝 李娇 陈绍基 TANG Yunman;LIU Yu;WANG Xuejun;MAO Yu;QIN Daorui;YANG Bo;PENG Kangjie;CHEN Zhu;LI Jiao;CHEN Shaoji(Department of Pediatric Surgery at Children’s Medical Center,Sichuan Provincial People’s Hospital,University of Electronic Science and Technology of China,Chengdu Sichuan,610072,P.R.China;Department of Urology,Chengdu Second People’s Hospital,Chengdu Sichuan,610021,P.R.China)

机构地区：[1]电子科技大学附属医院·四川省人民医院儿童医学中心小儿外科,成都610072 [2]成都市第二人民医院泌尿外科,成都610021

出　　处：《中国修复重建外科杂志》2022年第2期231-235,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(82101666)。

摘　　要：目的探讨尿道下裂初次矫治手术中阴茎脱套分离(脱套)、切断尿道板(断板)、阴茎海绵体背侧白膜折叠(背折)和筋膜皮肤覆盖操作对阴茎长度的影响。方法以209例青春期前初次治疗的尿道下裂患儿作为研究对象,年龄10~97个月,平均31.7个月。于术前(n=209)、脱套后(n=152)、断板后(n=139)、背折后(n=170)、筋膜皮肤覆盖后(n=209),测量阴茎牵拉长度并比较操作前后长度差异。根据术中处理,将患者分为断板组及保板组、背折组及未折组,同时将保板组进一步分为背折亚组及未折亚组;比较组间阴茎长度差异,分析上述处理对阴茎长度的影响。对脱套、断板、背折及筋膜皮肤覆盖处理前后阴茎长度差值与成形尿道长度、阴茎静息背侧长度、阴茎静息腹侧长度、术前阴茎长度及脱套后阴茎弯曲度进行多元线性回归分析,探讨阴茎长度的影响因素。结果矫治术中脱套、断板后阴茎长度较前增加(P<0.05),背折、筋膜皮肤覆盖后缩短(P<0.05),所有操作完成后阴茎长度较术前增加(P<0.05)。断板组术后阴茎长度较术前增加(P<0.05),而保板组手术前后差异无统计学意义(P>0.05);断板组术后阴茎增加长度大于保板组(P<0.05)。背折组术后阴茎长度较术前增加(P<0.05),未折组手术前后阴茎长度差异无统计学意义(P>0.05);两组术后阴茎增加长度差异无统计学意义(P>0.05)。保板组中,背折亚组与未折亚组组内手术前后阴茎长度比较,以及组间手术前后阴茎长度、术后阴茎增加长度比较,差异均无统计学意义(P>0.05)。脱套、背折及筋膜皮肤覆盖后阴茎增加长度与成形尿道长度、阴茎静息背侧长度、阴茎静息腹侧长度、术前阴茎长度及脱套后阴茎弯曲度无相关(P>0.05);成形尿道长度及术前阴茎长度是断板后阴茎增加长度的影响因素(P<0.05)。结论尿道下裂初次矫治手术中各主要操作均会改变阴茎长度,断板�Objective To document the effect of surgical steps, including penile degloving, plate transection,dorsal plication, and fasciocutaneous coverage, in primary hypospadias repair on penile length. Methods A consecutive series of 209 prepubertal boys with primary hypospadias repair was included with the age ranged from 10 to 97 months(mean, 31.7 months). Intraoperative stretched penile length(SPL) was measured before operation(n=209), and after each step, namely penile degloving(n=152), plate transection(n=139), dorsal plication(n=170), and fasciocutaneous coverage(n=209). SPLs before and after each steps or the entire operation were analyzed. The SPL was compared between plate transection group and plate preservation group, dorsal plication group and non-plication group, and plate preservation with plication group and plate preservation without plication group, respectively. Differences of SPL between before and after each steps were analyzed with factors including neourethra length, rest dorsal penile length, rest ventral penile length,preoperative SPL, and the degree of penile curvature after penile degloving, with multivariate linear regression analysis.Results All the four steps resulted in SPL difference. The SPL increased after penile degloving and plate transection(P<0.05), and decreased after dorsal plication and fasciocutaneous coverage(P<0.05). The SPL increased after all steps were completed(P<0.05). In patients with plate transection, postoperative SPL increased when compared with that before operation(P<0.05). No significant difference was noted in patients without plate transection(P>0.05). And there was significant difference in the increased length of SPL between patients with and without plate transection(P<0.05). In patients with dorsal plication, a significant increase of postoperative SPL(P<0.05) was noted. No significant difference was noted in patients without dorsal plication(P>0.05). And there was no significant difference in increased length between patients with and without dorsal plication

关 键 词：尿道下裂 阴茎长度 矫治手术 影响因素 

分 类 号：R726.9[医药卫生—儿科]