尿道下裂再手术后并发症的危险因素分析  

Analysis of Risk Factors for Complications Following Reoperation for Hypospadias

作　　者：潘永东 方晓亮[1] 徐国锋[1] Pan Yongdong;Fang Xiaoliang;Xu Guofeng(Department of Pediatric Urology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院儿泌尿外科,上海200092

出　　处：《临床小儿外科杂志》2025年第3期250-254,共5页Journal of Clinical Pediatric Surgery

基　　金：上海市科学技术委员会科研计划项目(23Y21900102)。

摘　　要：目的探讨尿道下裂再手术后并发症的危险因素。方法回顾性分析2019年12月至2021年12月上海交通大学医学院附属新华医院既往行1次及以上尿道下裂手术患儿的临床资料,根据末次手术后是否发生并发症,分为并发症组和无并发症组。收集两组既往手术情况、入院时症状、年龄、体重、术中所见、手术方式、手术时间、导尿管拔除时间、住院时长以及泌尿系统合并症情况,分析末次手术后出现并发症的危险因素。结果本研究共纳入106例患儿,按入院时症状分类:尿道瘘口93例,尿道狭窄8例,尿道憩室5例。末次手术后共36例出现并发症,其中尿道瘘口28例、尿道狭窄6例、尿道憩室2例。单因素分析结果显示,患儿年龄、手术病因(包括尿道瘘口位置)、手术次数与再手术后出现并发症有关(P<0.05),而手术类型、手术时长、是否存在其他泌尿系原发性疾病、总住院时长与再手术后出现并发症无关(P>0.05);多因素Logistic回归分析结果显示,患儿年龄偏大(OR=1.165,95%CI:1.023~1.321)、尿道狭窄(OR=3.825,95%CI:1.072~13.645)、根部瘘口(OR=0.411,95%CI:0.184~0.917)、既往手术次数2次(OR=3.434,95%CI:1.153~10.214)和既往手术次数3次及以上(OR=10.435,95%CI:1.474~12.451)是再手术后出现并发症的独立危险因素。结论对非首次手术的尿道下裂患儿,应根据患儿具体情况选择个体化手术方案,确保术中更精细的手术操作,加强术后高危患儿的护理,以减少并发症的发生。Objective To investigate the risk factors for complications following reoperation for hypospadias.Methods A retrospective analysis was conducted on the clinical data of children who underwent reoperation for hypospadias at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between December 2019 and December 2021.Patients were divided into two groups based on whether they experienced complications after the final surgery:the complication group and the non-complication group.Data collected included previous surgical history,symptoms at admission,age,weight,intraoperative findings,surgical method,duration of surgery,catheter removal time,length of hospital stay,and urinary system comorbidities.The risk factors for complications after the final surgery were analyzed.Results A total of 106 children were included in this study.Symptoms at admission were classified as:urethral fistula(93 cases),urethral stenosis(8 cases),and urethral diverticulum(5 cases).Complications occurred in 36 cases after the final surgery,including 28 cases of urinary fistula,6 cases of urethral stricture,and 2 cases of urethral diverticulum.Univariate analysis indicated that age,surgical etiology(including the location of the fistula),and the number of previous surgeries were risk factors for complications after reoperation(P<0.05),while surgical type,duration of surgery,presence of other primary urinary tract diseases,and total length of hospital stay were not associated with complications(P>0.05).Multivariate logistic regression analysis showed that age(OR=1.165,95%CI:1.023-1.321),urethral stenosis(OR=3.825,95%CI:1.072-13.645),root fistula(OR=0.411,95%CI:0.184-0.917),having undergone 2 previous surgeries(OR=3.434,95%CI:1.153-10.214),and having undergone 3 or more previous surgeries(OR=10.435,95%CI:1.474-12.451)were independent risk factors for complications following reoperation.Conclusions For children with hypospadias who are undergoing reoperation,individualized surgical plans should be chosen based on the child

关 键 词：尿道下裂 并发症 外科手术 儿童 

分 类 号：R726.9[医药卫生—儿科]