近端型尿道下裂第二期修复尿道同时矫治阴茎阴囊转位的疗效评价  

Efficacy of urethroplasty plus correcting penoscrotal transposition for proximal hypospadias during a second stage repair

作　　者：陈艳 黄轶晨[1] 谢华 吕逸清 吴旻[1] 陈方[1] Chen Yan;Huang Yichen;Xie Hua;Lyu Yiqing;Wu Min;Chen Fang(Department of Urology,Shanghai Children's Hospital,School of medicine,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院,上海交通大学医学院附属儿童医院泌尿外科,上海200062

出　　处：《中华小儿外科杂志》2022年第8期704-708,共5页Chinese Journal of Pediatric Surgery

基　　金：上海市科学技术委员会科技计划项目(21Y11903900)。

摘　　要：目的探讨合并阴茎阴囊转位的近端型尿道下裂第二期修复尿道同时矫治阴茎阴囊转位的可行性及预防阴茎阴囊交界处尿瘘的作用。方法收集2018年10月至2021年12月在上海市儿童医院采用Byars分期术式治疗合并阴茎阴囊转位的近端型尿道下裂56例,按第二期手术方式分为2组:A组30例,行尿道成形术(Duplay)+阴茎阴囊转位矫治术(改良Glenn-Anderson);B组26例,行尿道成形术(Duplay)。两组术后采用HOSE评分评估手术并发症,PPPS评分评估家长对患儿外生殖器术后外观的满意度。结果HOSE评分中位数(四分位数)A组16.00(15.00,16.00)分,B组14.00(14.00,15.25)分,两组比较差异有统计学意义(P<0.001)。PPPS评分中位数(四分位数)A组13.00(12.00,13.00)分,B组12.00(10.25,12.00)分,两组比较差异有统计学意义(P=0.003)。尿瘘发生率A组6.7%(2/30),B组19.2%(5/26),差异无统计学意义(P=0.231),其中位于阴茎阴囊交界处的尿瘘,A组为0例,B组为3例。结论合并阴茎阴囊转位的近端型尿道下裂第二期修复尿道同时矫治阴茎阴囊转位安全可行,不会增加手术并发症,同时可能减少阴茎阴囊交界处尿道瘘的发生。Objective To explore the efficacy of urethroplasty plus correcting penoscrotal transposition for proximal hypospadias during a second stage repair.Methods From October 2018 to December 2021,56 cases of proximal hypospadias plus penoscrotal transposition underwent Byar's staged operation.They were divided into two groups according to surgical approaches.In group A(n=30),urethroplasty(Duplay)and penoscrotal transposition correction(modified Glenn-Anderson)were performed as a second stage repair.While in group B(n=26),urethroplasty(Duplay)alone.The scores of hypospadias objective scoring evaluation(HOSE)and pediatric penile perception score(PPPS)were assessed for parental perception of urinary symptoms and cosmetic outcomes.Results The median HOSE and PPPS scores were 16.00(15.00,16.00)and 13.00(12.00,13.00)in group A versus 14.00(14.00,15.25)and 12.00(10.25,12.00)in group B.The inter-group difference of scores were statistically significant(P<0.001,P=0.003).The incidence of urinary fistula was 6.7%(2/30)in group A versus 19.2%(5/26)in group B(P=0.231).The inter-group difference had no statistical significance.In group A,no urinary fistula occurred in penoscrotal area and penile scrotal transposition was corrected satisfactorily.In group B,urinary fistulas(n=3)occurred in penoscrotal area.Conclusion During a second stage repair for proximal hypospadias,correcting penoscrotal transposition plus urethroplasty is both safe and feasible without higher surgical complications.It may lower the incidence of urethral fistula in penoscrotal area.

关 键 词：尿道下裂 阴茎阴囊转位 儿童 

分 类 号：R726.9[医药卫生—儿科]