复合皮瓣转移在尿道板纵切卷管尿道成形术中的应用  

Application of compound flap transfer in tubularized incised plate urethroplasty

作　　者：李圆 冯东川 朱孝宇 龚金超 韩涛 孙光耀 张习伦 胡殿贺 沙索友 Li Yuan;Feng Dongchuan;Zhu Xiaoyu;Gong Jinchao;Han Tao;Sun Guangyao;Zhang Xilun;Hu Dianhe;Sha Suoyou(Department of Pediatric Urology,the Affiliated Xuzhou Children’s Hospital of Xuzhou Medical University,Xuzhou 221006,China)

机构地区：[1]徐州医科大学附属徐州儿童医院泌尿外科,徐州221006

出　　处：《中华整形外科杂志》2023年第11期1229-1235,共7页Chinese Journal of Plastic Surgery

基　　金：江苏省青年医学人才项目(QNRC2016370);徐州市卫生健康委青年医学科技创新重点项目(XWKYHT20210524)。

摘　　要：目的探讨复合皮瓣转移在尿道板纵切卷管尿道成形术(TIP)中的应用效果。方法采用前瞻性随机对照设计,将2018年1月至2022年3月在徐州医科大学附属徐州儿童医院泌尿外科拟行TIP的尿道下裂患儿,采用随机数字法分为复合皮瓣转移组(A组)和传统TIP组(B组)。A组采用复合皮瓣转移改良的TIP术,改良主要体现在新建尿道的多层覆盖和游离皮片内嵌阴茎头切开处。B组采用经典的皮下筋膜覆盖TIP术。根据意向性分析(ITT)原则,A组和B组全部患儿纳入各自的全分析集(FAS);部分患者因失访、改换治疗方案等原因而未被纳入主要终点事件分析中,其余患儿纳入符合方案集(PPS)的A组及B组。分别对FAS和PPS进行统计分析,比较2组患儿年龄、阴茎头宽度、阴茎下弯度数、成形尿道长度、手术时间采用独立样本t检验或Wilcoxon秩和检验;尿道下裂分型、背侧海绵体白膜折叠比例、术后并发症发生率采用χ2检验或Fisher确切概率法进行分析,P<0.05为差异有统计学意义。结果根据ITT原则,FAS中A组纳入50例男性患儿,年龄为8个月至15岁2个月,平均年龄4岁;B组纳入50例男性患儿,年龄为10个月至14岁9个月,平均4岁1个月。PPS最终纳入A组为37例男性患儿,年龄为1岁2个月至12岁1个月,平均年龄4岁;B组为41例男性患儿,年龄为1岁2个月至11岁9个月,平均年龄4岁2个月。经统计分析发现,不管是FAS还是PPS,A组和B组患儿的年龄、尿道下裂分型、阴茎头宽度、阴茎下弯度数、背侧海绵体白膜折叠比例、成形尿道长度的差异均无统计学意义(P均>0.05),A组的平均手术时间长于B组,差异有统计学意义(P<0.05)。术后随访3~48个月,平均2年3个月。A组的并发症发生率低于B组[10.81%(4/37)vs.29.27%(12/41)],差异有统计学意义(P<0.05);其中尿瘘为8.11%(3/37)vs.14.63%(6/41),差异无统计学意义(P>0.05);尿道口狭窄为2.70%(1/37)vs.12.20%(5/41),差异无统计学意ObjectiveTo investigate the application effect of the compound flap transfer in tubularized incised plate(TIP)urethroplasty.MethodsChildren with hypospadias who received TIP in the Department of Pediatric Urology,the Affiliated Xuzhou Children’s Hospital of Xuzhou Medical University from January 2018 to March 2022 were prospectively divided into compound flap transfer group(group A)and traditional TIP group(group B)by random number method.Group A was treated with TIP modified by compound flap transfer,and group B was treated with traditional TIP covered with fascia.The improvement of the compound flap transfer for TIP operation is mainly reflected in the multi-layer cover of the new urethra and the free skin embedded in the incision of the penile head.According to the intention-to-treat(ITT)principle,the final full analysis set(FAS)includes both group A and group B.Some patients were excluded from the analysis of the primary endpoint events due to reasons such as loss to follow-up or treatment group switch.Additionally,the final per-protocol set(PPS)consisting of group A and group B,which adheres to the study protocol,is subjected to statistical analysis.Independent sample t-test or Wilcoxon rank sum test was used for average age,the width of the penile head,degree of chordee,length of neourethra,and operative time.The classification of hypospadias,proportion of dorsal tunica albuginea plication,and incidence of postoperative complications were compared using the Chi-square test or Fisher’s exact test,P<0.05 was considered statistically significant.ResultsAccording to ITT principles,50 children were included in FAS group A,ranging in age from 8 months to 15 years and 2 months,with an average age of 4 years.Group B included 50 children,ranging in age from 10 months to 14 years and 9 months,with an average age of 4 years and 1 month.Thirty-seven children in PPS group A were included,ranging in age from 1 year 2 months to 12 years 1 month,with an average age of 4 years.Group B consisted of 41 children,ranging in

关 键 词：尿道下裂 治疗结果 手术后并发症 阴茎 畸形 尿道成形术 

分 类 号：R726.9[医药卫生—儿科]