影响尿道下裂术后并发症危险因素的多中心研究  

Risk factors for postoperative complications of hypospadias:a multi-center clinical trial

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 吴旻[14] 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,Sichuan University,Chengdu 610044,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 Surgery,Affiliated Hospital,Zunyi Medical University,Zunyi 563003,China;Department of Urology,Xi'an Children's Hospital,Xi'an 710002,China;Department of Urology,Shani Children's Hospital,Taiyuan 030013,China;Department of Urology,Shenzhen Children's Hospital,Shenzhen 518038,China;Department of Pediatric Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030,China;Department of Pediatric Surgery,First Af filiated Hospital,Guangzi Medical University,Nanning 530021,China;Department of Urology,Affiliated Children's Hospital,Chongqing Medical University,Chongqing 400015,China;Department of Urology,Children's Hospilal of Jiangri Province,Nanchang 330006,China;Department of Urology,Shanghai Children's Hospital,Shanghai 200062,China;Department of Urology,Tianjin 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科,成都610072 [3]四川大学华西医院小儿外科,成都610044 [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,上海交通大学医学院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》2023年第4期329-337,共9页Chinese Journal of Pediatric Surgery

摘　　要：目的:通过分析多中心尿道下裂解剖学数据及术后随访结果,了解我国尿道下裂诊治现状,探讨影响尿道下裂术后并发症的危险因素。方法:回顾性分析2018年12月至2019年12月首都医科大学附属北京儿童医院、中国医科大学附属盛京医院等15家儿童医学中心首诊收治的包括随访在内数据完整的尿道下裂患儿的临床资料,分析患儿术式选择依据及不同术式并发症影响因素。单因素分析中不服从正态分布的计量资料组间比较采用Mann-Whitney U检验,计数资料组间比较采用卡方检验;选取单因素分析中P<0.05的影响因素纳入多因素logistic分析,计算OR值以及95%CI。采用受试者操作特征曲线(receiver operating characteristic curve,ROC)下的面积(area under the curve,AUC)来检验尿道缺损长度对尿道下裂术后并发症的分辨能力,并根据约登指数来确定最佳临界值。结果:符合纳入排除标准的患儿共1011例,按Barcat分型分为远端型248例、中间型214例、近侧型549例。其中尿道板纵切卷管尿道成形术(tubularized incised plate urethroplasty,TIP)组336例,并发症84例,并发症发生率为25.0%(84/336),包括尿道瘘53例(15.8%,53/336)、尿道狭窄29例(8.6%,29/336)、尿道憩室3例(0.9%,3/336)。单因素分析结果显示阴茎头宽度、尿道板舟状窝宽度、尿道板纵切后宽度是TIP术式术后并发症的危险因素,而手术时年龄、阴茎长度、阴茎头长度、尿道缺损长度、尿道板平整度及弹性不是TIP术式术后并发症危险因素。多因素logistic分析结果显示尿道板纵切后宽度(OR=0.836,95%CI:0.742~0.942,P=0.003)及阴茎头宽度(OR=0.851,95%CI:0.749~0.965,P=0.012)是TIP术式术后并发症的独立危险因素。根据尿道板纵切后宽度的ROC曲线图(AUC=0.649,P<0.001),计算出约登指数最大时获得临界值为11.5 mm。根据阴茎头宽度的ROC曲线图(AUC=0.630,P<0.001),计算出约登指数最大时获得临界值为15.5 mm。Objective To analyze the anatomical data of multi-center hypospadias and postoperative follow-up results to grasp the current status of diagnosing and treating hypospadias in China and examine the influencing factors of postoperative complications of hypospadias.Methods From December 2018 to December 2019,clinical data were reviewed for children with hypospadias hospitalized with complete follow-up data at 15 children's medical centers.Surgical options and influencing factors of postoperative complications were examined.In univariate analysis,Mann-Whitney U test was utilized for comparing measurement data not in a normal distribution and Chi-square test for processing counting data.The influencing single factors of P<0.05 were included for multivariate Logistic analysis and OR value and 95%CI calculated.Area under the curve(AUC)of receiver operating characteristic curve(ROC)was utilized for testing the capability of urethral defect length for distinguishing postoperative complications of hypospadias.Optimal critical value was determined according to the Youden index.Results A total of 1011 cases fulfilled the criteria of admission and discharge.According to Barcat classification,the clinical types were distal(n=248),intermediate(n=214)and proximal(n=549).In tubularized incised plate urethroplasty(TIP)group,336 cases developed 84 complications with a complication rate of 25.0%(84/336),including urethral fistula(15.8%,53/336),urethral stricture(8.6%,29/336)and urethral diverticulum(0.9%,3/336).Penile head width,plate width of urethral scaphoid fossa and plate width after longitudinal incision were the risk factors for postoperative complications of TIP;Operative age,penile length,penile head length,urethra defect length and flatness/elasticity of urethral plate were not the risk factors.Multivariate Logistic analysis indicated that urethral plate width after longitudinal incision(OR=0.836,95%CI:0.742-0.942)and penile head width(OR=0.851,95%CI:0.749-0.965)were independent risk factors for postoperative complications

关 键 词：尿道下裂 尿道成形术 并发症 

分 类 号：R726.9[医药卫生—儿科]