改良Koyanagi术对尿道下裂患儿排尿功能及疼痛因子的影响  

Effect of a modified Koyanagi procedure on voiding function and pain factors in children with hypospadias

作　　者：章捷 吴臻斐 田由 Zhang Jie;Wu Zhenfei;Tian You(Department of Surgery,Hangzhou Children's Hospital,Hangzhou 310000,Zhejiang Province,China)

机构地区：[1]杭州市儿童医院外科,杭州310000

出　　处：《中国基层医药》2024年第7期1027-1031,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨改良尿道板重建卷管尿道成形术(Koyanagi术)对尿道下裂患儿排尿功能及疼痛因子的影响。方法采用随机对照研究, 选取杭州市儿童医院于2019年1月至2020年12月收治的尿道下裂患儿80例, 按照随机数字表法分为研究组40例和对照组40例。研究组采用改良Koyanagi术治疗, 对照组行尿道口基底血管皮瓣尿道成形术。比较两组手术指标和并发症情况;术前和术后3 d疼痛因子水平的变化;术后12个月治疗效果和排尿功能变化。结果研究组术中出血量[(24.53±7.84)mL]少于对照组[(43.12±14.35)mL], 术后住院时间[(6.52±1.03)d]短于对照组[(7.84±1.26)d], 而手术时间[(132.42±16.56)min]长于对照组[(114.35±17.48)min], 差异均有统计学意义(t=7.19、5.13、4.74, 均P<0.05)。研究组并发症发生率为7.50%(3/40), 明显低于对照组的25.00%(10/40), 差异有统计学意义(χ^(2)=5.54, P=0.019)。研究组术后3 d血清P物质(SP)[(147.92±18.98)μg/L]、神经肽Y(NPY)[(74.34±5.65)mg/L]和前列腺素E2(PGE2)水平[(138.28±21.45)ng/L]均低于对照组[(189.47±21.25)μg/L、(93.51±6.58)mg/L和(179.95±24.34)ng/L](t=9.22、13.97、8.10, 均P<0.05)。研究组术后12个月治愈率为90.00%(36/40), 明显高于对照组的70.00%(28/40), 差异有统计学意义(χ^(2)=5.00, P=0.025)。研究组术后12个月排尿量[(140.92±12.84)mL]多于对照组[(133.27±10.32)mL], 平均尿流率[(8.54±0.38)mL/s]和最大尿流率[(12.76±1.32)mL/s]均高于对照组[(7.95±0.47)mL/s和(11.54±1.28)mL/s], 差异均有统计学意义(t=2.93、6.17、4.19, 均P<0.05)。结论尿道下裂患儿改良Koyanagi术效果显著, 且可显著改善患儿排尿功能, 抑制疼痛因子的释放。Objective To investigate the effect of urethral plate reconstruction and tubular urethroplasty(a modified Koyanagi procedure)on voiding function and pain factors in children with hypospadias.Methods A total of 80 children with hypospadias who were treated at Hangzhou Children's Hospital between January 2019 and December 2020 were included in this study.These children were divided into a study group and a control group,with 40 children in each group.The study group underwent modified Koyanagi surgery,while the control group received traditional urethral orifice basal vessel flap urethroplasty.The operative indicators and complications of hypospadias were compared between the two groups.Changes in pain factor levels were analyzed before and 3 days after surgery.Therapeutic effects and changes in voiding function were evaluated 12 months after surgery.Results The intraoperative blood loss in the study group[(24.53±7.84)mL]was significantly less than that in the control group[(43.12±14.35)mL),while the postoperative length of hospital stay[(6.52±1.03)days,t=7.19,P<0.05]in the study group was significantly shorter than that in the control group[(7.84±1.26)days,t=5.13,P<0.05].The surgical time in the study group[(132.42±16.56)minutes]was significantly longer than that in the control group[(114.35±17.48)minutes,t=4.74,P<0.05).The incidence of complications in the study group[7.50%(3/40)]was significantly lower than that in the control group[22.50%(10/40),χ^(2)=5.54,P=0.019].At 3 days after surgery,the serum levels of substance P[(147.92±18.98)μg/L],neuropeptide Y[(74.34±5.65)mg/L],and prostaglandin E_(2)[(138.28±21.45)ng/L]in the study group were significantly lower than those in the control group[(189.47±21.25)μg/L,(93.51±6.58)mg/L,(179.95±24.34)ng/L,t=9.22,13.97,8.10,all P<0.05].At 12 months after surgery,the cure rate in the study group was significantly higher than that in the control group[90.00%(36/40)vs.70.00%(28/40),χ^(2)=5.00,P=0.025].At 12 months after surgery,the study group had a higher posto

关 键 词：尿道下裂 修复外科手术 手术中并发症 手术时间 住院时间 疼痛 

分 类 号：R726.9[医药卫生—儿科]