尿道板纵切卷管尿道成形术后10年以上随访结果分析  

Follow-up results for over one decade after longitudinal transurethral plate resection and coil ure-throplasty

作　　者：叶安 叶茂飞[1] 叶惟靖 刘毅东[1] 吴旻[1] 庄利恺[1] 姜心诚[1] Ye An;Ye Maofei;Ye Weijing;Liu Yidong;Wu Min;Zhuang Likai;Jiang Xincheng(Department of Urology,Affiliated Renji Hospital,Shanghai Jiao Tong University,School of Medicine,Shanghai 200120,China)

机构地区：[1]上海交通大学医学院附属仁济医院泌尿科,上海200120 [2]珠海市妇幼保健院小儿外科,珠海519000

出　　处：《中华小儿外科杂志》2022年第6期539-543,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨不同程度尿道下裂患儿尿道板纵切卷管尿道成形术(tubularized incised plate urethroplasty,TIP)后10年以上的随访情况。方法收集2005年5月1日至2010年5月31日在上海交通大学医学院附属仁济医院采用TIP术初次治疗尿道下裂的362例患儿临床资料。患儿中位年龄为15个月,年龄范围为8~84个月;中位尿道缺损长度为1.5 cm,尿道缺损长度范围为0.5~3.0 cm。根据阴茎脱套后腹侧弯曲的程度进行区分,患儿阴茎弯曲度<15°为轻度下弯或无下弯,15°~35°为中度下弯,>35°为重度下弯。本研究中,轻度下弯或无下弯的患儿有254例,中度下弯的患儿有108例。根据阴茎腹侧弯曲矫正后尿道开口的位置进行区分,开口于冠状沟至阴茎根部远端的患儿为轻中度尿道下裂,开口于阴茎根部至会阴的患儿为重度尿道下裂,其中轻中度尿道下裂患儿有302例,重度尿道下裂患儿有60例。对所有患儿进行TIP术治疗,对中度下弯的患儿辅行阴茎背侧白膜折叠术。术后复查随访,记录患儿尿道狭窄、尿道瘘以及阴茎弯曲等并发症的发生情况。结果所有患儿术后随访10年以上,随访时间范围为10~15年,随访患儿年龄范围为11~24岁。随访期间共251例患儿返院完成尿流率检查,其中10.0%(25/251)的患儿手术后最大尿流率(maximum flow rate,MFR)低于正常值。关于MFR降低的情况,重度尿道下裂患儿的比例明显高于轻中度患儿,25.0%(15/60)比5.2%(10/191),差异具有统计学意义(P<0.001)。患儿尿道瘘发生率为9.4%(34/362),其中重度尿道下裂的患儿尿道瘘的发生率为8.3%(5/60),轻中度尿道下裂患儿尿道瘘的发生率为9.6%(29/302),两者间的差异无统计学意义(P>0.05)。尿道狭窄发生率为2.5%(9/362),其中重度尿道下裂患儿尿道狭窄的发生率明显高于轻中度尿道下裂患儿,10.0%(6/60)比1.0%(3/302),差异具有统计学意义(P<0.001)。阴茎再弯发生率为7.5%(27/362),27例中12例重度Objective To explore the follow-up status of children with varying degrees of hypospadias for over one decade after tubularized incised plate urethroplasty(TIP).Methods Clinical data were retrospectively reviewed for 362 children with hypospadias initially undergoing TIP between May 1,2005 and May 31,2010.The average age was 15(8-84)months and the average length of urethral defect 1.5(0.5-3.0)cm.It was distinguished according to the degree of ventral curvature after penile degloving.And penile curvature<15°was recurved mildly or not,15°to 35°moderately and>35°severely.There were mild or no inferior curvature(n=254)and moderate inferior curvature(n=108).According to the location of urethral opening after correcting ventral penile curvature,children with opening from coronal sulcus to distal end of penile root had mild-to-moderate hypospadias and those with opening from penile base to perineum had severe hypospadias,including mild-to-moderate hypospadias(n=302)and severe hypospadias(n=60).All of them underwent TIP and children with moderate recurvatum were assisted with dorsal tunica albuginea plication of penis.Postoperative re-examinations and follow-ups were performed for recording the occurrence of such complications as urethral stricture,urethral fistula and penile curvature.Results The follow-up period was(10-15)years and the follow-up age ranged from 11 to 24 years.During follow-ups,a total of 251 children returned for urological examinations.And 10.0%(25/251)had a maximal flow rate(MFR)lower than normal post-operation.Regarding a reduction of MFR,the proportion of children with severe hypospadias was significantly higher than that of those with mild-to-moderate hypospadis[25.0%(15/60)vs.5.2%(10/191)]and the difference was statistically significant(P<0.001).The incidence of urethral fistula was 9.4%(34/362),including severe hypospadias(8.3%,5/60)and mild-to-moderate hypospadias(9.6%,29/302).There was no significant inter-group difference(P>0.05).The incidence of urethral stricture was 2.5%(9/362).And the

关 键 词：尿道下裂 尿道成形术 阴茎弯曲 长期随访 

分 类 号：R699[医药卫生—泌尿科学]