后尿道瓣膜症后尿道扩张程度与病情严重程度及预后的相关性  

Correlation of posterior urethral dilatation with severity and prognosis of posterior urethral valvular disease

作　　者：孔德建 陈家蓉[1] 杨诗 陈嘉波[2] KONG Dejian;CHEN Jiabo;YANG Shi(Department of Pediatric Surgery,Maternal and Child Health Care Hospital of Guangxi Zhuang Autonomous Region,Nanning 530005,China)

机构地区：[1]广西壮族自治区妇幼保健院小儿外科,广西南宁530005 [2]广西医科大学第一附属医院小儿外科

出　　处：《临床外科杂志》2023年第3期279-282,共4页Journal of Clinical Surgery

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20190370)。

摘　　要：目的研究后尿道瓣膜症后尿道扩张程度与病情严重程度及预后的相关性。方法选取2018年1月~2020年12月于我院及广西医科大学第一附属医院收治的后尿道瓣膜症患儿80例,所有患儿均做排泄性膀胱尿道造影测量后尿道的长度及宽度,并行经尿道膀胱镜尿道瓣膜电切术。随访1年后根据预后情况分为预后不良组和预后良好组。比较两组患儿临床资料、排尿情况、尿流率、残余尿、尿路感染、膀胱形态、肾及输尿管积水、膀胱输尿管反流、肾功能等情况。应用多因素Logistic回归分析影响尿道瓣膜症术后预后情况的相关因素。结果80例患儿中有6例脱落,有29例术后预后不良,仍存在排尿困难等情况,为预后不良组,剩余45例预后良好为预后良好组,预后不良的发生率为39.19%。预后不良组后尿道扩张严重程度、有膀胱壁增厚及小梁增生、合并膀胱功能障碍所占的比例均大于预后良好组,差异有统计学意义(P<0.05)。多因素Lo-gistic回归分析显示,后尿道扩张长度(OR=8.880)、后尿道扩张宽度(OR=9.410)和有膀胱壁增厚及小梁增生(OR=5.375)是后尿道瓣膜症病情严重程度及影响术后预后的独立危险因素。结论后尿道扩张严重程度和有膀胱壁增厚及小梁增生是影响后尿道瓣膜症术后预后的危险因素,早期监测有助于了解病情严重程度及调整治疗方案。Objective To study the correlation between posterior urethral dilation and the severity and prognosis of posterior urethral valvular disease.Methods A total of 80 children with posterior urethral valve disease who were admitted to the pediatric surgery department of our hospital from January 2018 to December 2020 were selected.All the children underwent voiding cystourethrogram VCUG to measure the width of the urethra,and underwent transurethral cystoscopy for urethral valve electrotomy.Clinical data,urination,urine flow rate,residual urine,urinary tract infection,bladder morphology,hydronephrosis of kidney and ureter,vesicoureteral reflux,and renal function were compared between the two groups.Multivariate Logistic regression was used to analyze the correlation factors of postoperative prognosis of urethral valvular disease.Results Among the 80 patients included in the study,6 cases fell off,29 cases had poor prognosis and dysuria after operation,and were divided into the poor group,and the remaining 45 cases were divided into the control group,with the incidence of poor prognosis being 39.19%.The proportion of urethral dilatation length,urethral dilatation width,bladder wall thickening and trabecular hyperplasia and bladder dysfunction in the adverse group were higher than those in the control group(P<0.05).Multivariate Logistic regression analysis showed that urethral dilation length(OR=8.880),urethral dilation width(OR=9.410),bladder wall thickening and trabecular hyperplasia(OR=5.375)were independent risk factors for the prognosis of posterior urethral valvular disease.Conclusion The length and width of urethral dilation,thickening of bladder wall and trabecular hyperplasia are the risk factors affecting the prognosis of urethral valvular disease.Early monitoring is helpful to understand the severity of urethral valvular disease and adjust the treatment plan.

关 键 词：后尿道瓣膜症 后尿道扩张 排泄性膀胱尿道造影 预后 

分 类 号：R726.9[医药卫生—儿科]