横裁包皮岛状皮瓣管状尿道成形术术后并发症相关因素分析  

Complications after proximal hypospadias repairing through one-stage transverse preputial island tube urethroplasty

作　　者：刘鑫[1] 刘舸[1] 杨屹[1] Liu Xin;Liu Ge;Yang Yi(Department of Pediatric Surgery,Affiliated Shengjing Hospital,China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿外科,沈阳110004

出　　处：《中华小儿外科杂志》2022年第8期691-696,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的评估一期横裁包皮岛状皮瓣管状尿道成形术治疗儿童近端型尿道下裂的手术治疗效果,总结分析术后并发症的相关因素。方法收集2012年12月至2022年1月中国医科大学附属盛京医院小儿泌尿外科初次行一期横裁包皮岛状皮瓣管状尿道成形术式治疗的近端型尿道下裂患儿290例的临床资料,患儿中位年龄19个月(11~167个月),中位随访时间54个月(2~126个月)。总结其临床特点,将患儿年龄、尿道外口位置、手术修复方式、阴茎头直径、成形尿道长度、二次覆盖方式、术前是否应用雄激素治疗作为潜在的影响因素,与术后是否出现并发症经单因素分析后做Logistic回归分析,以P<0.05作为差异具有统计学意义的标准。结果纳入研究的290例患儿中,64.83%(188/290)的患儿无尿道成形术相关的并发症;35.17%(102/290)的患儿术后出现尿道成形术相关的并发症,其中18.96%(55/290)的患儿出现尿道瘘,11.38%(33/290)的患儿出现尿道狭窄,4.83%(14/290)的患儿出现尿道憩室。统计学分析提示患儿初次手术年龄、尿道外口位置、阴茎头直径、手术修复方法、术前是否使用雄激素治疗与术后并发症无相关性(P>0.05);新成形尿道额外覆盖、阴茎腹曲程度与术后并发症相关(P<0.05)。结论一期横裁包皮岛状皮瓣管状尿道成形术治疗儿童近端型尿道下裂术后并发症发生率仍然很高,其中最常见的是尿道瘘。新成形尿道额外覆盖可以降低术后并发症发生率;包皮脱套横断尿道板后阴茎腹曲角度大会增加术后并发症发生的风险。Objective To evaluate the clinical outcomes of proximal hypospadias using one-stage transverse preputial island tube urethroplasty,summarize and analyze the related factors of complications of primary repair of proximal hypospadias in children.Methods From December 2012 to January 2022,clinical data were retrospectively reviewed for complications after hypospadias operation in 290 children.Various clinical characteristics were summarized.Age,lesion grade,surgical approaches,diameter of glans,length of neourethra,secondary coverage and preoperative testosterone were examined while potential factors for postoperative complications analyzed by Logistic regression.P<0.05 was deemed as a statistical criterion.Results Postoperative complications occurred(n=102,35.17%),including fistulas(n=55,18.96%),urethral strictures(n=33,11.38%)and urethral diverticulum(n=14,4.83%).Statistical analysis indicated that ventral curvature after degloving and transecting urethral plate,length of neourethra and tunica vaginalis flap over neourethra were correlated with postoperative complications(P<0.05).Conclusion Even performed by highly experienced surgeons,proximal hypospadias has remained challenging.Transverse preputial island tube urethroplasty has a high incidence of complications.Urethrocutaneous fistula is one of the most common complications after one-stage operation.Ventral curvature after degloving and transecting urethral plate and tunica vaginalis flap over neourethra are related factors affecting the postoperative complications after proximal hypospadias repair in children.

关 键 词：尿道下裂 尿道狭窄 尿道瘘 尿道憩室 手术后并发症 

分 类 号：R726.9[医药卫生—儿科]