Yang Zhilin,Zhang Peiliang,He Yingying,et al.Impacts of glanular width and urethral plate width on tubularized incised plate urethroplasty complications in children with hypospadias[J].Journal of Clinical Pediatric Surgery,2024,(06):555-560.[doi:10.3760/cma.j.cn101785-202209022-009]
阴茎头宽度和尿道板宽度对尿道下裂TIP手术后并发症的影响分析
- Title:
- Impacts of glanular width and urethral plate width on tubularized incised plate urethroplasty complications in children with hypospadias
- Keywords:
- Hypospadias; Surgical Procedures; Operative; Penis; Urethra; Postoperative Complications; Root Cause Analysis
- 摘要:
- 目的 探讨尿道下裂尿道板纵切卷管尿道成形(tubularized incised plate urethroplasty,TIP)手术后并发症的影响因素。 方法 本研究为回顾性研究,以2019年1月至2021年6月深圳市儿童医院泌尿外科同一治疗组收治的接受TIP手术的尿道下裂患儿作为研究对象,根据是否出现并发症将患儿分为并发症组和无并发症组,收集两组患儿手术年龄、尿道口位置、尿道板宽度、阴茎头宽度、尿道缺损长度、手术时间以及术后并发症情况(包括尿道瘘、尿道狭窄、龟头裂开等), 采取二元Logistic回归分析TIP手术后并发症的影响因素。 结果 本研究共纳入尿道下裂患儿275例,平均年龄3.7岁(1.0~16.0岁);阴茎头宽度 ≥13 mm者240例, <13 mm者35例;尿道板宽度<8 mm者224例,≥8 mm者51例。275例均获随访,随访时间1~3年,其中17例(17/275,6.2%)术后出现并发症,包括尿道瘘12例、尿道狭窄2例、龟头裂开4例(其中1例同时合并尿道瘘和尿道狭窄)。尿道板宽度≥8 mm组与尿道板宽度<8 mm组并发症发生率差异无统计学意义[(2/51,3.9%)比(15/24,6.7%),P=0.448]。阴茎头宽度≥13 mm组较阴茎头宽度<13 mm组并发症发生率低,差异有统计学意义[(3.8%,9/240)比(8/35,22.9%),P=0.001]。单因素Logistic回归分析结果显示,术后并发症的影响因素包括尿道外口位置、阴茎头宽度、尿道缺损长度以及手术时间(P＜0.05);多因素Logistic回归分析结果显示,TIP手术后并发症的独立影响因素为阴茎头宽度(OR=0.624,95%CI:0.423~0.920,P=0.017),尿道板宽度与TIP手术后并发症无关(P＞0.05) 。 结论 阴茎头宽度可影响尿道下裂TIP手术后并发症的发生率,对于阴茎头宽度<13 mm的尿道下裂,需要慎重考虑行TIP手术;临床可不必根据尿道板宽度来决定是否行TIP手术。
- Abstract:
- Objective To explore the impact factors of tubularized incised plate (TIP) urethroplasty complications Methods From January 2019 to June 2021,prospective review was conducted for 272 children with hypospadias undergoing TIP urethroplasty.Operative age,meatus location,urethral plate width,glans width,urethral defect,operative duration and postoperative complications of urethral fistula,urethral stricture and glanular dehiscence were recorded.They were assigned into two groups of complication and normal.Multi-factorial Logistic regression analysis was performed for examining the correlation of observation factors and postoperative complications.Results Mean age was 3.7(1-16) year.Glanular width was ≥13 mm (n=240) and <13 mm(n=35).Urethral width was <8 mm (n=224) and ≥8 mm (n=51).During a follow-up period of (1-3) year,17 children (6.2%) developed urethral complications of urethral fistulas (n=12),urethral stricture (n=2) and glanular dehiscence (n=4).No significant difference existed between children with urethral plate ≥8 mm and <8 mm [2/51(3.9%) vs.15/24(6.7%),P=0.448] .Complication rate was lower in children with glanular width ≥13 mm than those with glanular width <13 mm [3.8%(9/240) vs.8/35(22.9%),P=0.001].Univariate Logistic regression indicated that meatus location,glanular width,urethral defect and operative duration were potential impact factors.However,multiple Logistic regression revealed that glanular width was the only impact factor of postoperative complications.Conclusions Glanular width is a risk factor of postoperative complications after TIP urethroplasty.For glanular width under 13 mm,TIP repair is recommended without a consideration of urethral plate width.
参考文献/References:
[1] Bergman JEH,Loane M,Vrijheid M,et al.Epidemiology of hypospadias in Europe:a registry-based study[J].World J Urol,2015,33(12):2159-2167.DOI:10.1007/s00345-015-1507-6.
[2] Zu’bi F,Chua M,El Ghazzaoui A,et al.Competency in tubularized incised plate repair for distal hypospadias:cumulative sum learning curve analysis of a single surgeon experience[J].J Urol,2020,204(6):1326-1332.DOI:10.1097/JU.0000000000001231.
[3] Alshafei A,Cascio S,Boland F,et al.Comparing the outcomes of tubularized incised plate urethroplasty and dorsal inlay graft urethroplasty in children with hypospadias:a systematic review and meta-analysis[J].J Pediatr Urol,2020,16(2):154-161.DOI:10.1016/j.jpurol.2020.01.009.
[4] Snodgrass WT.Tubularized incised plate (TIP) hypospadias repair[J].Urol Clin North Am,2002,29(2):285-290.DOI:10.1016/s0094-0143(02)00045-9.
[5] Holland AJA,Smith GHH.Effect of the depth and width of the urethral plate on tubularized incised plate urethroplasty[J].J Urol,2000,164(2):489-491.DOI:10.1016/S0022-5347(05)67408-3.
[6] Snodgrass WT,Nguyen MT.Current technique of tubularized incised plate hypospadias repair[J].Urology,2002,60(1):157-162.DOI:10.1016/s0090-4295(02)01620-5.
[7] Eldeeb M,Nagla S,Abou-Farha M,et al.Snodgrass vs snodgraft operation to repair the distal hypospadias in the narrow urethral plate[J].J Pediatr Urol,2020,16(2):165.e1-165.e8.DOI:10.1016/j.jpurol.2020.01.006.
[8] Sarhan OM,El-Hefnawy AS,Hafez AT,et al.Factors affecting outcome of tubularized incised plate (TIP) urethroplasty:single-center experience with 500 cases[J].J Pediatr Urol,2009,5(5):378-382.DOI:10.1016/j.jpurol.2009.02.204.
[9] Snodgrass W,Cost N,Nakonezny PA,et al.Analysis of risk factors for glans dehiscence after tubularized incised plate hypospadias repair[J].J Urol,2011,185(5):1845-1849.DOI:10.1016/j.juro.2010.12.070.
[10] Zhang B,Ruan SS,Bi YL.Urethral plate in tubularized incised plate urethroplasty:how wide is enough?[J].Transl Androl Urol,2021,10(2):703-709.DOI:10.21037/tau-20-1243.
[11] 刘愉,覃道锐,王学军,等.初治尿道下裂TIP手术后并发症的相关因素分析:309例单中心研究[J].临床小儿外科杂志,2020,19(12):1094-1099.DOI:10.3969/j.issn.1671-6353.2020.12.007. Liu Y,Qin DR,Wang XJ,et al.Analysis of related factors of complications after tubularized incised plate for initial hypospadias:a single-center report of 309 cases[J].DOI:10.3969/j.issn.1671-6353.2020.12.007.
[12] Bush NC,Snodgrass W.Pre-incision urethral plate width does not impact short-term tubularized incised plate urethroplasty outcomes[J].J Pediatr Urol,2017,13(6):625.e1-625.e6.DOI:10.1016/j.jpurol.2017.05.020.
[13] Bush NC,Villanueva C,Snodgrass W.Glans size is an independent risk factor for urethroplasty complications after hypospadias repair[J].J Pediatr Urol,2015,11(6):355.e1-355.e5.DOI:10.1016/j.jpurol.2015.05.029.
[14] Yildiz T,Tahtali IN,Ates DC,et al.Age of patient is a risk factor for urethrocutaneous fistula in hypospadias surgery[J].J Pediatr Urol,2013,9(6 Pt A):900-903.DOI:10.1016/j.jpurol.2012.12.007.
[15] 方一圩,宋宏程,孙宁,等.尿道下裂横裁带蒂包皮岛状皮瓣尿道成形术后近期并发症的危险因素分析[J].临床小儿外科杂志,2022,21(1):18-23.DOI:10.3760/cma.j.cn.101785-202107006-004. Fang YW,Song HC,Sun N,et al.Risk factors for short-term complications after transverse preputial island flap urethroplasty for hypospadias repairing[J].J Clin Ped Sur,2022,21(1):18-23.DOI:10.3760/cma.j.cn.101785-202107006-004.
[16] Viseshsindh W.Factors affecting results of hypospadias repair:single technique and surgeon[J].J Med Assoc Thai,2014,97(7):694-698.
[17] Bush NC,Holzer M,Zhang S,et al.Age does not impact risk for urethroplasty complications after tubularized incised plate repair of hypospadias in prepubertal boys[J].J Pediatr Urol,2013,9(3):252-256.DOI:10.1016/j.jpurol.2012.03.014.
相似文献/References:
[1]杜朝峻,丁力,胡英超,等.手术治疗婴幼儿法洛四联症83例[J].临床小儿外科杂志,2010,9(06):413.
DU Chao jun,DING Li,HU Ying chao,et al.Surgical treatment of Tetralogy of Fallot in infancy: Experiences of 83 cases.[J].Journal of Clinical Pediatric Surgery,2010,9(06):413.
[2]李勇,尹强,周小渔,等.术中胆道造影在先天性胆总管囊肿手术中的应用[J].临床小儿外科杂志,2010,9(06):430.
LI Yong,YIN Qiang,ZHOU Xiao yu,et al.The clinic application experience on intraoperative cholangiography in pediatric surgery.[J].Journal of Clinical Pediatric Surgery,2010,9(06):430.
[3]许芝林,王强,李琰,等.乙状结肠冗长症的术式选择探讨[J].临床小儿外科杂志,2010,9(06):432.
XU Zhi lin,WANG Qiang,LI Yan,et al.Initiatory exploration of the standard of surgical treatment methods for Dolichosigmoid.[J].Journal of Clinical Pediatric Surgery,2010,9(06):432.
[4]常绘文,沈振亚.右腋下小切口在儿童心内手术中的应用[J].临床小儿外科杂志,2010,9(06):439.
[5]罗洪,孙德霞,强红家,等.不同部位皮肤再造尿道的病理学研究[J].临床小儿外科杂志,2010,9(06):443.
[6]胡明,施诚仁,严志龙.脐环小切口治疗婴幼儿腹盆腔疾病的探讨[J].临床小儿外科杂志,2010,9(06):471.
[7]江峰赵阳孙莲萍金惠明马杰.婴幼儿阻塞性脑积水两种手术方式的疗效比较[J].临床小儿外科杂志,2011,10(01):0.
JIANG Feng,ZHAO Yang,SUN Liang ping,et al.Endoscopic third ventricul ostomy versus ventricul operitoneal shunt:clinical study of obstructive hydro cephalus in infants.[J].Journal of Clinical Pediatric Surgery,2011,10(06):0.
[8]王伟程少文彭磊林忠勤张伟陈庆玉寇冬权.弹性髓内钉在儿童肱骨骨折中的应用[J].临床小儿外科杂志,2011,10(01):0.
WANG Wei,CHENG Shaowen,PENG Lei,et al.Application of elastic intramedullary nailing in pediatric humeral fractures.[J].Journal of Clinical Pediatric Surgery,2011,10(06):0.
[9]陈快 黄金狮 戴康临 陶俊峰 赖勇强 陶强. 腹腔镜与开腹Ladd手术治疗新生儿肠旋转不良效果比较[J].临床小儿外科杂志,2011,10(02):128.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):128.
[10]郑里乐 许慧萍 彭牡丹. 产时子宫外胎儿手术的护理配合[J].临床小儿外科杂志,2011,10(02):157.
[J].Journal of Clinical Pediatric Surgery,2011,10(06):157.
[11]丁勇,魏华,孔燕,等.横裁包皮岛状皮瓣法在尿道下裂治疗中的应用[J].临床小儿外科杂志,2010,9(06):474.
[12]景登攀张根领孙蔓丽.改良Snodgrass术治疗尿道下裂疗效观察[J].临床小儿外科杂志,2011,10(01):0.
[13]白明 张敬悌 葛文安 王盛兴 郭涛 张岗 杨增雷. 医用透明硅胶膜在尿道下裂手术伤口包扎中的应用[J].临床小儿外科杂志,2012,11(02):91.
[14]刘波 陈太忠 李光亮 舒中甫 石代红 杨英.改良尿道板纵切卷管尿道成型术治疗儿童尿道下裂６例[J].临床小儿外科杂志,2013,12(01):72.
[15]贾幸,谢华.尿道下裂阴茎下弯的组织学和手术治疗研究进展[J].临床小儿外科杂志,2019,18(09):795.[doi:10.3969/j.issn.1671-6353.2019.09.018]
Jia Xing,Xie Hua.Research advances in histology and surgery of ventral penile curvature in hypospadias[J].Journal of Clinical Pediatric Surgery,2019,18(06):795.[doi:10.3969/j.issn.1671-6353.2019.09.018]
[16]郭慧杰,孙雪蕊,李守林,等.儿童尿道下裂TIP手术后近期尿流率变化研究[J].临床小儿外科杂志,2023,22(02):129.[doi:10.3760/cma.j.cn101785-202211059-006]
Guo Huijie,Sun Xuerui,Li Shoulin,et al.Variation tendency of urinary flow after tubularized incised plate urethroplasty in children with hypospadias[J].Journal of Clinical Pediatric Surgery,2023,22(06):129.[doi:10.3760/cma.j.cn101785-202211059-006]
[17]杨珍珍,李佳义,刘沛,等.一期Duckett与分期Bracka尿道成形术治疗非远端型尿道下裂术后并发症的Meta分析[J].临床小儿外科杂志,2023,22(02):168.[doi:10.3760/cma.j.cn101785-202202018-014]
Yang Zhenzhen,Li Jiayi,Liu Pei,et al.Efficacy of one-stage Duckett versus staged Bracka urethroplasty for nondistal hypospadias: a meta-analysis[J].Journal of Clinical Pediatric Surgery,2023,22(06):168.[doi:10.3760/cma.j.cn101785-202202018-014]
[18]王登辉,崔梦杰,韩晓江,等.性别发育异常合并近端尿道下裂尿道成形术后并发症的危险因素分析[J].临床小儿外科杂志,2023,22(09):849.[doi:10.3760/cma.j.cn101785-202211056-010]
Wang Denghui,Cui Mengjie,Han Xiaojiang,et al.Risk factors of complications after urethroplasty in children with gender dysplasia and proximal hypospadias[J].Journal of Clinical Pediatric Surgery,2023,22(06):849.[doi:10.3760/cma.j.cn101785-202211056-010]
[19]周谦,张潍平,宋宏程,等.尿道板切开卷管尿道成形术治疗尿道下裂的近期疗效及术后尿道瘘相关危险因素分析[J].临床小儿外科杂志,2023,22(12):1139.[doi:10.3760/cma.j.cn101785-202202009-009]
Zhou Qian,Zhang Weiping,Song Hongcheng,et al.Analysis of risk factors for urethral fistula of hypospadias repair with tubularized incised plate urethroplasty[J].Journal of Clinical Pediatric Surgery,2023,22(06):1139.[doi:10.3760/cma.j.cn101785-202202009-009]
备注/Memo
收稿日期:2022-09-15。
基金项目:广东省高水平医院建设专项经费资助(2020-2024);深圳市医学重点学科(SZXK035)
通信作者:李守林,Email:lishoulin83008088@163.com