近端型尿道下裂治疗现状及近期预后分析的多中心研究  

A multicenter study of treatment status and short-term prognosis of proximal hypospadias

作　　者：方一圩 宋宏程[1] 孙宁[1] 张潍平[1] 唐耘熳[2] 王学军[2] 黄鲁刚[3] 曾莉[3] 杨屹[4] 刘鑫[4] 潮敏 张晔 马洪 刘红 张敬悌[7] 康磊[7] 张旭辉[8] 孟庆明[8] 李守林[9] 谢谨谨[9] 周学锋[10] 李宁 陈超 苏成 何大维[12] 刘星[12] 吴文波[13] 唐静[13] 谢华[14] 吴旻 关勇[15] 王欣[15] Fang Yiwei;Song Hongcheng;Sun Ning;Zhang Weiping;Tang Yunman;Wang Xuejun;Huang Lugang;Zeng Li;Yang Yi;Liu Xin;Chao Min;Zhang Ye;Ma Hong;Liu Hong;Zhang Jingti;Kang Lei;Zhang Xuhui;Meng Qingming;Li Shoulin;Xie Jinjin;Zhou Xuefeng;Li Ning;Chen Chao;Su Cheng;He Dawei;Liu Xing;Wu Wenbo;Tang Jing;Xie Hua;Wu Min;Guan Yong;Wang Xin(Department of Urology,Beijing Children's Hospital,Capital Medical University Beijing 100045,China;Department of Pediatric Surgery,Sichuan Academy of Medical Sciences,Sichuan Provincial People's Hospital,Chengdu 610072,China;Department of Pediatric Surgery,West China Hospital of Sichuan University,Chengdu 610041,China;Department of Pediatric Urology,Affiliated Shengjing Hospital,China Medical University,Shenyang 110004,China;Department of Pediatric Urology,Anhui Children's Hospital,Hefei 230022,China;Department of Pediatric Urology&General Thoracic Surgery,Affiliated Hospital,Zunyi Medical University,Zunyi 563003,China;Department of Urology,Municipal Children's Hospital,Xi'an 710002,China;Department of Urology,Shanxi Children's Hospital,Taiyuan 030013,China;Department of Urology,Municipal Children's Hospital,Shenzhen 518038,China;Department of Pediatric Urology,Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,WuHan 430030,China;Department of Pediatric Urology,First Affiliated Hospital,Guangxi Medical University,Nanning 530021,China;Department of Urology,Children's Hospital,Chongqing Medical University,Chongqing 400015,China;Department of Urology,Children's Hospital of Jiangxi Province,Nanchang 330006,China;Department of Urology,Shanghai Children's Hospital,Shanghai Jiaotong University,Shanghai 200062,China;Department of Urology,Municipal Children's Hospital,Tianjin 300134,China)

机构地区：[1]首都医科大学附属北京儿童医院泌尿外科,北京100045 [2]四川省医学科学院·四川省人民医院小儿外,成都610072 [3]四川大学华西医院小儿外科,成都610041 [4]中国医科大学附属盛京医院小儿泌尿外科,沈阳110004 [5]安徽省儿童医院小儿泌尿外科,合肥230022 [6]遵义医科大学附属医院小儿普胸泌外科,遵义563003 [7]西安市儿童医院泌尿外科,西安710002 [8]山西省儿童医院泌尿外科,太原030013 [9]深圳市儿童医院泌尿外科,深圳518038 [10]华中科技大学同济医学院附属同济医院小儿外科,武汉430030 [11]广西医科大学附属第一医院小儿外科,南宁530021 [12]重庆医科大学附属儿童医院泌尿外科,重庆400015 [13]江西省儿童医院泌尿外科,南昌330006 [14]上海市儿童医院,上海交通大学附属儿童医院泌尿外科,上海200062 [15]天津市儿童医院泌尿外科,天津300134

出　　处：《中华小儿外科杂志》2022年第8期685-690,共6页Chinese Journal of Pediatric Surgery

基　　金：国家重点研发计划(2016YFC1000807)。

摘　　要：目的应用多中心数据研究近端型尿道下裂的手术方式选择和预后影响因素。方法收集2018年12月至2019年12月国内15家儿童临床中心首诊治疗且随访数据完整的近端型尿道下裂549例患儿的临床资料,其中矫正阴茎下弯后尿道开口位于阴茎近端196例、阴茎阴囊交界处132例、阴囊147例、会阴74例。按手术方式进行分组,其中TIP术式占9.5%(52/549)、Onlay术式占4.7%(26/549)、Duckett术式占59.2%(325/549)、Duckett+Duplay术式占5.5%(30/549)、Koyanagi术式占9.7%(53/549)、分期术式占11.5%(63/549)。分析不同术式的治疗效果及影响预后的相关因素。结果阴茎长度平均3.68 cm;阴茎头长度平均10.5 mm;阴茎头宽度平均10.5 mm;尿道缺损长度平均3.52 cm。阴茎下弯平均57.5°。尿道缺损长度及阴茎下弯度数各组差异有统计学意义(P<0.001)。TIP术式组中88.5%的尿道板弹性良好。尿道板弹性及平整度各术式组差异有统计学意义(P<0.001)。549例平均随访时间26个月,并发症发生率43.7%(240/549),其中TIP术式组并发症发生率30.8%(16/52),Onlay术式组并发症发生率38.5%(10/26),Duckett术式组并发症发生率52.9%(172/325),Duckett+Duplay术式组并发症发生率40%(12/30),Koyanagi术式组并发症发生率30.2%(16/53),分期术式组并发症发生率22.2%(14/63)。6组术式术后并发症发生率差异具有统计学意义(P<0.001)。结论近端型尿道下裂治疗难度大,一期术式术后并发症率发生率30.2%~52.9%。需根据阴茎的具体条件严格选择合适的手术方式。对于近端型尿道下裂,当尿道板平整度及弹性差或合并重度阴茎下弯时,不能应用TIP术式,需选择横断尿道板的术式,当尿道缺损长且阴茎下弯严重时,可选用分期术式。Objective To explore the prognosis and influencing factors of proximal hypospadias based on multicentre data.Methods From December 2018 to December 2019,clinical data were retrospectively reviewed for children with proximal hypospadias initially admitted into 15 children's medical centers in China with complete follow-ups.The subjects were assigned into groups according to different urethroplasty approaches.A total of 549 cases fulfilled the criteria,including TIP 9.5%(52/549),Onlay 4.7%(26/549),Duckett 59.2%(325/549),Duckett plus Duplay 5.5%(30/549),Koyanagi 9.7%(53/549)and staged operation 11.5%(63/549).Therapeutic outcomes and prognostic factors of different surgical approaches were analyzed.Results Penile traction length averaged 3.68 cm,penile head length 10.5 mm,penile head width 10.5 mm,urethral defect length 3.52 cm and penile curve 57.5 degrees.Statistically significant differences existed in urethral defect length and penile curvature among all groups(P<0.001).In TIP group,88.5%urethral plate had an excellent elasticity.Statistically significant differences existed in elasticity/flatness of urethral plate among different surgical groups(P<0.001).The average follow-up period was 26 months.The overall complication rate was up to 43.7%(240/549).The complication rate was 30.8%(16/52)in TIP group,38.5%(10/26)in Onlay group,52.9%(172/325)in Duckett group,40%(12/30)in Duckett+Duplay,30.2%(16/53)in Koyanagi and 22.2%(14/63)in staged operation.The incidence of postoperative complications differed greatly among six groups(P<0.001).Conclusion The management of proximal hypospadias remains problematic and the postoperative complication rate of one-stage operation is 30.2%-52.9%.Operations should be customized according to the specific conditions of penis.TIP is contra-indicated for proximal hypospadias with poor flatness or elasticity of urethral plate or severe concomitancy of ventral curvature.However,transverse urethral plate may be adopted.For long urethral defect with severe ventral curvature,staged operation

关 键 词：尿道下裂 尿道板 阴茎下弯 

分 类 号：R726.9[医药卫生—儿科]