尿道支架管冲洗在预防青春期尿道下裂患儿术后并发症中的疗效评估  

Evaluation of the efficacy of urethral stent tube irrigation in preventing postoperative complications among adolescents with hypospadias

作　　者：叶子涵 王冲 刘丽[1,2] 吴盛德[1,2] 张德迎[1,2] 何大维[1,2] 刘星[1,2] 魏光辉 Ye Zihan;Wang Chong;Liu Li;Wu Shengde;Zhang Deying;He Dawei;Liu Xing;Wei Guanghui(Department of Urology,Children’s Hospital of Chongqing Medical University,Chongqing 400014,China;Chongqing Key Laboratory of Child Urogenital Development and Tissue Engineering,Chongqing Key Laboratory of Pediatrics,Key Laboratory of Child Development and Disorders of Ministry of Education,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,National Clinical Research Center for Child Health and Disorders,Chongqing Key Laboratory of Structural Birth Defect and Reconstruction,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院泌尿外科,重庆400014 [2]儿童泌尿生殖发育与组织工程重庆市重点实验室儿科学重庆市重点实验室儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地国家儿童健康与疾病临床医学研究中心医院结构性出生缺陷与器官修复重建重庆市重点实验室,重庆400014

出　　处：《中华整形外科杂志》2024年第12期1289-1295,共7页Chinese Journal of Plastic Surgery

基　　金：国家自然科学基金(81970571);重庆医科大学未来医学青年创新团队发展支持计划(3001112)。

摘　　要：目的探讨尿道支架管冲洗对预防青春期尿道下裂患儿术后并发症的效果。方法回顾性分析重庆医科大学附属儿童医院泌尿外科2016年4月至2023年7月收治的青春期尿道下裂患儿临床资料,根据术中是否在尿道内置入细导管分为对照组和研究组。所有患儿均由同一位医生完成尿道成形术。患儿术前2 d开始每日使用沐浴液和5%聚维酮碘搓洗术区。对照组患儿术后单纯留置尿管引流;研究组患儿在尿管引流基础上于后尿道内置入细支架管,术后用生理盐水进行尿道灌注冲洗。术后观察伤口感染、尿瘘、尿道狭窄、尿道憩室等并发症发生情况。计数资料以频数、百分数表示,采用χ^(2)检验或基于蒙特卡洛法的χ^(2)检验进行分析;正态分布的计量资料用±s表示,采用t检验进行分析;非正态分布的计量资料以M(Q_(1),Q_(3))表示,采用Wilcoxon秩和检验进行分析。以P<0.05为差异有统计学意义。结果共纳入76例患儿。其中,对照组43例,年龄12.9(12.2,13.7)岁,重建尿道长度为(3.88±1.86)cm;研究组33例,年龄12.5(11.3,14.1)岁,重建尿道长度为(3.30±1.45)cm。对照组术后有32例(74.4%)患儿出现并发症,其中伤口感染24例(55.8%),尿瘘16例(37.2%),尿道狭窄6例(14.0%),尿道憩室2例(4.7%);研究组术后有1例(3.0%)患儿出现伤口感染和尿瘘。研究组术后伤口感染、尿瘘和总并发症发生率明显低于对照组(P均<0.01)。结论青春期尿道下裂患儿术后采用尿道支架管冲洗尿道可以有效降低伤口感染和尿瘘的发生率。Objective:To evaluate the effect of urethral stent tube irrigation in preventing postoperative complications in adolescents with hypospadias.Methods:A retrospective analysis was conducted using the clinical data of adolescents with hypospadias treated at the Department of Urology,Children’s Hospital of Chongqing Medical University,from April 2016 to July 2023.Patients were divided into control group and study group according to whether urethral stent tube was inserted in urethra during operation.All surgeries were performed by the same surgeon.For two days before surgery,patients were instructed to cleanse the surgical site daily with body wash and a 5%povidone-iodine solution.In the control group,patients received postoperative care with an indwelling urinary catheter.In the study group,in addition to the urinary catheter,a urethral stent tube was placed in the posterior urethra,and postoperative urethral irrigation with saline was performed.Postoperative complications,including wound infection,urethral fistula,urethral stricture,and urethral diverticulum,were monitored.Categorical data were expressed as frequencies and percentages and were analyzed using theχ^(2) test or Monte Carlo-basedχ^(2) test.Continuous data with normal distribution are presented as Mean±SD and were analyzed using the t-test.Non-normally distributed continuous data were expressed as M(Q_(1),Q_(3))and were analyzed using the Wilcoxon rank-sum test.P<0.05 was considered statistically significant.Results:A total of 76 patients were enrolled in the study,with 43 patients in the control group[median age 12.9(12.2,13.7)years,reconstructed urethral length(3.88±1.86)cm]and 33 patients in the study group[median age 12.5(11.3,14.1)years,reconstructed urethral length(3.30±1.45)cm].Postoperatively,32 patients(74.4%)in the control group experienced complications,including 24 cases(55.8%)of wound infection,16 cases(37.2%)of urethral fistula,6 cases(14.0%)of urethral stricture,and 2 cases(4.7%)of diverticulum.In the study group,only 1 patient(3.0

关 键 词：尿道下裂 青春期 手术后并发症 尿道支架管 效果评估 

分 类 号：R47[医药卫生—护理学]