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(12):1139-1145.[doi:10.3760/cma.j.cn101785-202202009-009]
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
- Title:
- Analysis of risk factors for urethral fistula of hypospadias repair with tubularized incised plate urethroplasty
- Keywords:
- Hypospadias; Surgical Procedures; Operative; Treatment Outcome; Postoperative Complications; Risk Factors; Child
- 摘要:
- 目的 探讨尿道板切开卷管尿道成形术(tubularized incised plate,TIP)治疗尿道下裂的近期疗效及术后发生尿道瘘的危险因素。方法 回顾性分析2018年12月至2020年1月在首都医科大学附属北京儿童医院泌尿外科初次行TIP手术治疗的尿道下裂患儿临床资料,通过电子手术记录和电话随访收集患儿临床资料,总结近期疗效,并对影响尿道瘘发生的可能因素进行单因素分析,选取单因素分析结果中有统计学意义的变量进行多因素Logistic回归分析。结果 本研究共纳入126例尿道下裂患儿,124例获随访,2例失访,平均随访时间20.2个月。患儿中位年龄24个月。不同尿道开口位置人数占比分别为:前型58.1%(72/124),中间型29.8%(37/124),后型12.1%(15/124)。术前存在不同程度阴茎下弯人数占比分别为:轻度29.8%(37/124),中度54.8%(68/124),重度15.3%(19/124)。约59.5%(22/37)的轻度阴茎下弯和33.8%(23/68)的中度阴茎下弯病例仅采用阴茎皮肤脱套,重度阴茎下弯(19/19)病例均采用阴茎皮肤脱套和背侧白膜折叠的方法。手术后近期并发症发生率为26.6%,其中尿道狭窄10例(10/124,8.1%),尿道瘘23例(23/124,18.5%),阴茎体瘘17例(17/124,13.7%),阴茎头裂开6例(6/124,4.8%)。单因素分析发现,年龄、术前阴茎下弯程度、新尿道覆盖物与TIP手术后尿道瘘之间无显著关联性,阴茎头宽度小于14 mm、后型尿道下裂、皮肤脱套后阴茎下弯超过15°以及行背侧白膜折叠是TIP手术后尿道瘘的可疑危险因素(P＜0.05)。多因素分析显示,阴茎头宽度小于14 mm是TIP术后尿道瘘的独立危险因素(P＜0.05)。结论 TIP手术治疗前型和中间型尿道下裂效果满意,治疗后型尿道下裂尿道瘘的发生率高;阴茎头宽度越小,皮肤脱套后阴茎下弯程度更重的患儿尿道瘘发生率更高。阴茎头宽度小于14 mm是TIP手术后尿道瘘的独立危险因素;TIP手术中利用Buck筋膜覆盖者尿道瘘的发生率更低,但发生尿道狭窄的可能性更大。
- Abstract:
- Objective To evaluate the efficacy and risk factors of urethral fistula with tubularized incised plate urethroplasty (TIPU).Methods From December 2018 to January 2020,126 children with hypospadias undergoing primary TIPU were consecutively recruited.General demographics and intraoperative data were recorded.Electronic surgical records were reviewed and telephone follow-ups conducted,including types and occurrence time of complications.Univariate analysis was conducted for potential risk factors of urethral fistula.Variables with statistical significance were selected for Logistic multivariate analysis.Results During a mean follow-up period of 20.2 mouths,2 cases were lost.Median age was 24 months.The position of urethral opening accounted for 58.1% of anterior type,29.8% of intermediate type and 12.1% of posterior type respectively.The preoperative proportion of mild/moderate/severe penile curvature was 29.8%,54.8% and 15.3% respectively.Penile curvature was corrected by penile degloving and dorsal plication.And 59.5% of children with mild penile curvature and 33.8% of moderate penile curvature were corrected only by degloving while all cases of severe penile curvature managed by dorsal plication.The overall complication rate of TIP surgery was 26.6%,including urethral stricture (n=10,8.1%),urethral fistula (n=23,18.5%),penile fistula (n=17,13.7%) and penile head fissure (n=6,4.8%).In univariate analysis,age,surgeon experiences or new urethra coverage had no correlation with postoperative urethral fistula.Urethral fistula was significantly higher in smaller glans,posterior hypospadias,severer penile curvature after degloving and chordee requiring dorsal plication.In multivariate analysis,glans width<14 mm were independent risk factors for postoperative urethral fistula with TIP.Conclusions TIPU has a satisfactory efficacy for anterior/mediate hypospadias.The incidence of urethral fistula for posterior hypospadias is high with a poor efficacy.Children with smaller glans or severer penile curvature after degloving have a higher incidence of urethral fistula and glans width<14 mm are independent risk factors for postoperative urethral fistula after TIPU.As compared to covering foreskin vascular pedicle,TIP surgery using Buck’s fascia coverage has a lower incidence of urethral fistula.However,the incidence of urethral stricture is higher.The indications of TIP surgery should be strictly controlled for lowering the incidence of postoperative complications.
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备注/Memo
收稿日期:2022-2-7。
基金项目:国家重点研发项目(2016YFC1000800)
通讯作者:张潍平,Email:zhangwp59616406@126.com