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(09):849-854.[doi:10.3760/cma.j.cn101785-202211056-010]
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
- Title:
- Risk factors of complications after urethroplasty in children with gender dysplasia and proximal hypospadias
- Keywords:
- Disorders of Sex Development; Hypospadias; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨性别发育异常(disorders of sex development,DSD)合并近端尿道下裂患儿尿道成形术后并发症的危险因素。方法 回顾性分析2012年1月至2020年1月郑州大学第一附属医院小儿泌尿外科收治的40例DSD合并近端尿道下裂患儿临床资料,随访时间均超过2年。收集患儿首次入院时年龄、DSD类型、术前合并疾病、尿道成形术式、尿道成形长度、外生殖器雄性化评分(external masculinization score,EMS)、术前是否应用激素治疗、术后近期并发症等情况,分析DSD合并近端尿道下裂患儿术后出现近期并发症的影响因素。结果 40例患儿入院时年龄1岁1个月至10岁8个月,平均年龄3岁8个月;尿道成形术后出现并发症10例(10/40,25％),其中尿瘘7例,尿道狭窄1例,尿道裂开1例,术后反流性附睾炎1例;并发症组与无并发症组患儿术前应用激素治疗[(2/10)比(19/30)]、EMS评分[5.5(4,8)比8(7,8)]及合并小阴茎[(6/10)比(5/30)]比较,差异具有统计学意义(P<0.05),而两组患儿入院年龄[39.0(18.75,58.50)比30.5(22.00,38.75)]、DSD类型[(3/10)比(4/10)比(3/10)]、尿道成形长度[一期5.0(5.0,6.0)比3.0(2.0,4.0),分期4.5(4.25,8.75)比5.0(4.5,6.5)]比较,差异无统计学意义(P＞0.05)。结论 对于DSD合并近端尿道下裂患儿,术前应用激素治疗、EMS低以及合并小阴茎可能导致术后近期并发症发生率升高。
- Abstract:
- Objective To explore the risk factors of complications after urethroplasty in children with DSD (disorders of sex development) plus proximal hypospadias.Methods From January 2012 to January 2020,clinical data were retrospectively reviewed for 40 DSD children with concurrent proximal hypospadias admitted with a follow-up period of no less than 2 years.Age of an initial admission,type of DSD,preoperative comorbidities,surgical approaches of urethroplasty,length of urethroplasty,external masculinization score (EMS),preoperative use of hormone therapy and recent postoperative complications were recorded.The influencing factors of recent postoperative complications in DSD children with concurrent proximal hypospadias.Results The average age was 44(13-128) month.A total of 10 cases (10/40,25%) of complications occurred,including urinary fistula (n=7),urethral stricture (n=1),urethral rupture (n=1) and postoperative reflux epididymitis(n=1).There was a statistically significant difference (P<0.05) in preoperative hormone therapy[(2/10)vs.(19/30)], EMS score[5.5(4,8)vs. 8(7,8)], and the presence of small penises[(6/10)vs.(5/30)] between the complication group and the non complication group, while there was no statistically significant difference (P>0.05) in admission age[39.0(18.75,58.50)vs. 30.5(22.00,38.75)], DSD type[(3/10)vs.(4/10)vs.(3/10)], and urethroplasty length[Primary 5.0(5.0,6.0)vs.3.0(2.0,4.0),Staged 4.5(4.25,8.75)vs. 5.0(4.5,6.5)] between the two groups. Conclusion For DSD children with concurrent proximal hypospadias,preoperative hormone therapy,EMS and presence of a small penis are risk factors for the occurrence of short-term postoperative complications.
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备注/Memo
收稿日期:2022-11-29。
基金项目:河南省联合重点基金项目(SBGJ202002042)
通讯作者:范应中,Email:fanyingzhong2@163.com