摘要
目的 探讨运用一期手术及分期手术治疗重度尿道下裂(阴茎伸直后尿道开口位于阴茎根部、阴茎阴囊交接部及会阴部)手术效果的差异。方法 回顾性分析首都医科大学附属北京儿童医院泌尿外科2009年1月至2013年12月收治的病历资料完善的重度尿道下裂患儿765例的临床资料。按手术方法不同分为一期手术组(650例)和分期手术组(115例)。分析比较两组患儿手术年龄、尿道缺损长度及术后尿道瘘、尿道憩室、尿道狭窄发生率差异。结果 一期手术组650例平均初次手术年龄29月龄(7~130月龄),尿道缺损长度均值为4.01 cm(2.00~8.00 cm);分期手术组115例平均初次手术年龄34月龄(8~156月龄),尿道缺损长度均值为4.33 cm(3.00~9.00 cm),两组患儿手术年龄和尿道缺损长度差异均无统计学意义(P〉0.05)。一期组术后总并发症发生率为30.5%(198/650),分期组为33.9%(39/115),组间比较,差异无统计学意义(χ2=0.544,P〉0.05)。一期组术后尿道瘘发生率为16.0%(104/650),分期组为31.3%(36/115),组间比较,差异有统计学意义(χ2=15.307,P〈0.05)。一期组术后尿道憩室发生率为14.0%(91/650),分期组为2.6%(3/115),组间比较,差异有统计学意义(χ2=11.764,P〈0.05)。一期组术后尿道狭窄发生率为7.5%(49/650),分期组为4.3%(5/115),组间比较,差异无统计学意义(χ2=1.516,P〉0.05)。结论 对于重度尿道下裂,一期手术和分期手术效果无明显差异,但是一期手术术后尿道瘘发生率较低,而分期手术术后尿道憩室发生率较低。
Objective To explore the difference of urethral complications between one-stage and two-stage repair of severe hypospadias.Methods A total of 765 patients underwent repairing of severe hypospadias from January 2009 to December 2013. They were divided into two groups of one-stage repair (Duckett & Duckett plus Duplay) (A, n=650) and two-stage repair (B, n=115). Two groups were compared with regards to age, length of urethral defect, rate of urethral fistula, urethral diverticulum and urethral stricture.Results In group A, the mean age was 29(7-130) months and the mean length of urethral defect 4.01(2.00-8.00) cm; in group B, the mean age was 34(8-156) months and mean length of urethral defect 4.33(3.00-9.00) cm. No difference of statistic significance existed in age, length of urethral defect (P〉0.05, P〉0.05) or rate of urethral complications [group A 30.5%(198/650) vs group B 33.9%(39/115), χ2=0.544, P〉0.05]. Difference of statistic significance existed in rate of urethral fistula [group A 16.0%(104/650), group B 31.3%(36/115), χ2=15.307, P〈0.05] and rate of urethral diverticulum [group A 14.0%(91/650) vs group B 2.6%(3/115), χ2=11.764, P〈0.05]. There was no difference of statistic significance in rate of urethral stricture [group A 7.5%(49/650) vs group B 4.3%(5/115), χ2=1.516, P〉0.05].Conclusions For overall complications of severe hypospadias, there is no difference of statistic significance between one-stage and two-stage repairing. However, the rate of urethral fistula is lower after one-stage repair and the rate of urethral diverticulum tends to be lower after two-stage repair.
出处
《中华小儿外科杂志》
CSCD
2017年第12期883-887,共5页
Chinese Journal of Pediatric Surgery
基金
教育部高等学校博士学科点专项科研基金(20111107110007)