摘要
目的:比较在近端型尿道下裂患儿中,使用阴茎深筋膜加盖于游离包皮尿道成形术与横裁包皮岛状皮瓣尿道成形术在术后并发症、阴茎外观等方面的效果。方法:前瞻性研究2017年12月至2019年12月期间于复旦大学附属儿科医院厦门医院就诊的近端型尿道下裂,需手术治疗的59例患儿。患儿按随机数字表法分为两组,研究组(29例)行游离包皮移植物卷管尿道成形术+阴茎深筋膜加盖,对照组(30例)行横裁包皮岛状皮瓣尿道成形术+常规筋膜覆盖。所有患儿经6个月以上随访比较两组患儿术后尿道狭窄、憩室等并发症率、尿道下裂阴茎评分(hypospadias objective penile evaluation,HOPE)、尿流率检测等指标。符合正态分布的计量资料采用t检验,不符合正态分布的计量资料采用Mann-Whitney U检验;计数资料采用卡方检验或Fisher精确概率法检验。结果:所有患儿均顺利完成手术,共55例患儿完成随访,研究组27例,对照组28例。两组在手术年龄、随访时间、阴茎长度、阴茎下弯程度、手术时间上差异均无统计学意义(均P>0.05);两组在尿道狭窄、尿道瘘、尿道憩室等单项并发症和总体并发症率以及尿流率上差异均无统计学意义(均P>0.05)。研究组总HOPE得分为(52.8±2.7)分,显著高于对照组[(47.6±3.1)分,t=5.27,P<0.001];其中研究组阴茎皮肤外观得分为(8.9±1.4)分,显著高于对照组[(6.0±2.1)分,t=4.83,P<0.001],研究组阴茎扭转得分为(9.4±1.1)分,显著高于对照组[(7.2±1.7)分,t=4.79,P<0.001]。结论:游离包皮移植物卷管尿道成形术联合阴茎深筋膜加盖,与横裁包皮岛状皮瓣尿道成形术相比,没有增加术后并发症的发生,但有更好的阴茎外观,减少了阴茎术后臃肿、扭转外观。
Objective To compare the efficacy of deep penile fascia covering plus prepuce graft tube urethroplasty versus transverse preputial island flap urethroplasty during proximal hypospadias repair.Methods Prospective review was conducted for 59 children operated for proximal hypospadias from December 2017 to December 2019.They were randomized into two groups of study and control.The study group underwent deep penile fascia covering plus prepuce graft tube urethroplasty while the control group had transverse prepuce island flap urethroplasty plus conventional fascia overlay.During a follow-up period of over 6 months,two groups were compared with regards to complication rates of urethral strictures and diverticula,Hypospadias Objective Penile Evaluation(HOPE)scores and urinary flow rate.And t-test was utilized for measurement data conforming to a normal distribution.Otherwise Mann-Whitney U test was utilized;Chi-square or Fisher's exact probability test for counting data.Results All operations were successful.A total of 55 children completed follow-ups(27 in study group vs 28 in control group).No significant inter-group differences existed in age,follow-up period,penile length,degree of penile curvature,length of new urethra or operation-related data(all P>0.05).Total HOPE score of study group was significantly higher than that of control group(52.8±2.7 vs 47.6±3.1)(t=5.27,P<0.001).Among them,appearance of penile skin and penile torsion were two major aspects(8.9±1.4 vs 6.0±2.1,t=4.83,P<0.001;9.4±1.1 vs 7.2±1.7,t=4.79,P<0.001).Conclusions As compared with transverse preputial island flap urethroplasty,deep penile fascia covering plus prepuce graft tube urethroplasty do not increase the incidence of postoperative complications during proximal hypospadias repair.Also it offers better penile cosmetics,reduces postoperative bloating and enhances torsional penile appearance.
作者
李昌佩
周维
王翔
夏凡
章奇
杨墨文
陈燕星
周高熙
Li Changpei;Zhou Wei;Wang Xiang;Xia Fan;Zhang Qi;Yang Mowen;Chen Yanting;Zhou Gao xi(Department of Urology,Children's Hospital of Fudan University at Xiamen(Xiamen Children's Hospital),Xiamen 361006,China;Department of Urology,Children's Hospital of Fudan University,Shanghai 201102,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2023年第4期338-344,共7页
Chinese Journal of Pediatric Surgery
基金
厦门市儿童医院1125人才工程(202006)
厦门市医疗卫生指导性项目(3502Z20214ZD1245)。
关键词
尿道下裂
阴茎深筋膜
游离移植
Hypospadias
Deep fascia of penis
Free transplantation
