Yu Kechi,Li Ning,Yuan Jiyan,et al.Long-term outcomes for the uses of tubularized incised plate procedure in hypospadias surgery[J].Journal of Clinical Pediatric Surgery,2020,19(12):1076-1081.[doi:10.3969/j.issn.1671-6353.2020.12.004]
TIP手术治疗儿童尿道下裂的远期疗效分析
- Title:
- Long-term outcomes for the uses of tubularized incised plate procedure in hypospadias surgery
- 分类号:
- R726.9;R697+.11;R695
- 摘要:
- 目的 探讨TIP手术治疗儿童尿道下裂的远期疗效。方法 回顾性收集2002年1月至2007年12月在华中科技大学同济医学院附属同济医院小儿外科接受TIP手术的尿道下裂患者临床资料和随访信息，随访方式为电话询问或门诊面谈及体格检查。随访内容包括：①姓名、年龄、教育程度、职业等一般资料；②排尿是否有力、有无喷洒、有无尿后滴沥等排尿功能情况（自我描述及尿动力检查）；③有无性生活、勃起功能（疼痛、勃起障碍）、有无射精问题、患者阴茎外观满意评估（满意、基本满意和不满意）等；④外生殖器总体外观、阴茎头形态、尿道外口位置及有无阴茎下弯等。结果 初诊接受TIP手术治疗的尿道下裂患者620例，其中随访到509例（82.1%），失访111例（失访率17.9%）。509例患者手术时年龄4~17.5岁，平均年龄5.8岁，随访截点年龄为17~33岁，平均年龄21.5岁。教育程度：初中228例（45%），高中214例（42%），本科61例（12%），研究生6例（1%）。职业：在校学生66例（13%），务工人员361例（71%），个体经营户26例（5%），其他职业56例（11%）。排尿功能：排尿无力、尿线不远9例（1.8%），排尿呈花洒样、尿线不集中87例（17.1%），排尿后滴沥14例（2.7%），排尿时阴茎腹侧有局限隆起6例（1.2%）。阴茎外观及性生活情况：468例（468/509，91.9%）有性生活史，勃起不适感99例（99/468，21.2%），勃起时疼痛67例（67/468，14.3%），射精无力37例（37/468，7.9%）。有性生活的468例获随访者中，203例性功能异常者所经历的平均手术次数明显高于265例性功能正常者（2.3±0.65 vs.1.4±0.67），差异有统计学意义（t=2.929，P=0.009）。412例患者对阴茎外观满意或比较满意，满意度为80.9%（412/509）。体格检查发现阴茎头均有冠状沟形态，尿道外口位于正常阴茎头顶端418例（418/509，82.1%），尿道外口位于冠状沟者91例（91/509，17.9%）。阴茎再下弯88例（88/509，17.3%），均为DonnahooⅠ型至Ⅲ型，<20°者25例，≥ 20°者63例，阴茎再下弯患者中有65例（65/88，73.9%）接受了再次阴茎矫正手术。结论 TIP手术是治疗儿童尿道下裂的主要术式之一，远期效果满意，需严格掌握手术适应证，警惕阴茎再下弯的发生；TIP手术近期并发症导致的手术次数增加可能会增加患者发生性功能异常的风险。
- Abstract:
- Objective To explore the long-term outcomes of tubularized incised plate (TIP) procedure for hypospadias.Methods From January 2002 to December 2007,clinical data of 620 children with hypospadias undergoing TIP procedure were analyzed retrospectively.Telephone inquiries and outpatient physical examinations were included for follow-ups.The follow-up details included general profiles (name,age,education & occupation),function of urination (subjective self-descriptions & objective dynamic examinations),sexual life & penile appearance,physical examination (general appearance of external genitalia,shape of penile head & position of urethral opening with or without re-chordee).Results A total of 509 cases (82.1%) were followed up.The average age was 5.8(4-17.5) years and the average follow-up period 21.5(17-33) years.Education:junior middle school (n=228,45%),senior high school (n=214,42%),bachelor’s degree (n=61,12%) and postgraduate degree (n=6,1%).Occupation:students (n=66,13%),workers (n=361,71%),self-employed (n=26,5%) and others (n=56,11%).Micturition function:weak micturition (n=9,1.8%),micturition (n=87,17.0%),urine drain (n=14,2.7%),and urethral diverticula (n=6,1.2%).And there were erection discomfort (n=99,21.2%),pain during erection (n=67,14.3%) and ejaculatory weakness (n=37,7.9%).There was an overall degree of satisfaction of 80.9%.And 418 cases (82.1%) had normal coronal groove morphology while another 91 cases (17.9%) with urethra external orifice in coronal groove.Penile chordee was<20° (n=25,4.9%) and ≥ 20 (n=63,12.4%).Conclusion TIP is one popular surgery for pediatric hypospadias.The cases with abnormal urination or re-chordee received TIP procedure should be taken seriously.
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备注/Memo
收稿日期:2019-09-20。
基金项目:湖北省卫生健康委员会面上项目（编号：WJ2019M135）
通讯作者:周学锋,Email:xfzhou@tjh.tjmu.edu.cn