离断尿道板一期尿道成形术后并发症的多因素分析  

Multifactor analysis of postoperative complications after one-stage urethroplasty with severed urethral plate

作　　者：胡建军 赵夭望[1] 陈毅夫[1] 祖建成[1] 童方运 刘宇[1] 何天衢 彭柳成 Hu Jianjun;Zhao Yaowang;Chen Yifu;Zu Jiancheng;Tong Fangyun;Liu Yu;He Tianqu;Peng Liucheng(Department of Urology,Hunan Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院泌尿外科,长沙410007

出　　处：《国际泌尿系统杂志》2023年第6期1000-1006,共7页International Journal of Urology and Nephrology

基　　金：湖南省卫生健康委课题(202204052510);国家临床重点专科建设项目(湘卫医发[2022]2号);湖南省儿童泌尿生殖疾病临床医学研究中心(2021SK4017)。

摘　　要：目的通过多因素分析离断尿道板一期尿道成形术后并发症的临床特点, 为离断尿道板一期尿道成形术后并发症的防治提供思路。方法回顾性分析2020年12月至2021年12月本院收治的325例行离断尿道板一期尿道成形术患者的临床资料, 其中采用Duckett术式201例(61.8%)、Duckett+Duplay术式90例(27.7%)、改良Koyanagi术式34例(10.5%), 根据术后有无并发症将患者分为并发症组(82例)及无并发症组(243例)。术后随访12~60周, 总结临床诊治特点, 采用多因素logistic回归分析尿道成形术后并发症的影响因素。结果术后并发症组患者中出现尿道瘘33例(40.2%), 尿道狭窄28例(34.1%), 尿道憩室7例(8.5%), 伤口感染14例(17.1%)。无并发症组与并发症组的年龄、尿道下裂分型、阴茎下弯程度、尿道长度、居住地区、术后照护人身份、照护人学历、是否留守儿童、手术者手术量级、龟头宽度、是否合并前列腺囊、是否低出生体重、是否早产、C反应蛋白(CRP)比较, 差异均有统计学意义(均P<0.05)。术后第1天CRP预测术后并发症发生的最佳临界值为11.5 mg/L, 灵敏度为0.793, 特异度为0.955, AUC曲线下面积为0.898;术后第1天白细胞计数(WBC)预测术后并发症发生的最佳临界值为10.3×10^(9)/L时, 灵敏度为0.695, 特异度0.403, AUC曲线下面积为0.516。将单因素分析中差异有统计学意义的因素纳入多因素logistic回归分析, 结果显示:年龄(OR=1.54, 95%CI:1.27~1.88, P<0.01)、尿道下裂分型(OR=3.43, 95%CI:1.04~11.31, P=0.043);阴茎下弯程度(OR=2.85, 95%CI:1.05~7.77, P=0.041)、手术者手术量级(OR=2.71, 95%CI:1.44~5.12, P=0.002)、CRP(OR=1.45, 95%CI:1.25~1.68, P<0.01)均为术后并发症发生的独立危险因素。结论离断尿道板一期尿道成形为治疗国内尿道下裂重要的手术方式, 年龄、尿道下裂分型、阴茎下弯程度、手术者手术量级、术后CRP是术后并发症的重要影响因素。Objective To analyze the clinical characteristics of postoperative complications after one-stage urethroplasty with severed urethral plate by multiple factors,and to provide ideas for the prevention and treatment of postoperative complications after one-stage urethroplasty with severed urethral plate.Methods The clinical data of 325 cases of one-stage urethroplasty with transection of urethral plate from December 2020 to December 2021 were retrospectively analyzed.Duckett procedure was used in 201 cases(61.8%)and Duckett+Duplay procedure was used in 90 cases(27.7%),34 cases(10.5%)of modified Koyanagi procedure,all of them underwent one-stage urethroplasty with transection of urethral plate.They were divided into complication group and non-complication group.After 12 to 60 weeks of follow-up,243 cases were in non-complication group and 82 cases were in complication group.The clinical characteristics of diagnosis and treatment were summarized,and the influencing factors of postoperative complications after urethroplasty were analyzed by multivariate logistic regression.Results There were 33 cases of urethral fistula(40.2%),28 cases of urethral stricture(34.1%),7 cases of urethral diverticulum(8.5%),and 14 cases of wound infection(17.1%).Age,subtype of hypospadias,degree of penile curvature,length of urethra,area of residence,identity of postoperative caregiver,education of caregiver,left-behind child,surgical magnitude,glans width,prostatic sac,low birth weight,preterm birth and C-reactive protein(CRP)were compared between the uncomplicated group and the complication group.The differences were statistically significant(all P<0.05).The optimal critical value of CRP for predicting postoperative complications on the first day after surgery was 11.5 mg/L,the sensitivity was 0.793,the specificity was 0.955,and the area under the AUC curve was 0.898.When the optimal critical value of white blood cell(WBC)for predicting postoperative complications was 10.3×10^(9)/L on the first day after surgery,the sensitivity was 0.695

关 键 词：尿道下裂 尿道成形术阴茎下弯 

分 类 号：R699.6[医药卫生—泌尿科学]