Hu Jianjun,Zhao Yaowang,Chen Yifu,et al.Analysis of risk factors for postoperative complications of urethroplasty in children with disorders of sex development after male gender reassignment[J].Journal of Clinical Pediatric Surgery,2026,(06):534-540.[doi:10.3760/cma.j.cn101785-20260328-00141]
性发育异常患儿男性性别重建尿道成形术后并发症的危险因素分析
- Title:
- Analysis of risk factors for postoperative complications of urethroplasty in children with disorders of sex development after male gender reassignment
- Keywords:
- Disorder of Sex Development; Urogenital Surgical Procedures; Treatment Outcome; Postoperative Complications; Risk Factors
- 摘要:
- 目的 探讨性发育异常(disorders of sex development,DSD)患儿男性性别重建尿道成形术后并发症的危险因素,为优化临床诊疗策略、降低并发症发生率提供参考。方法 本研究为病例对照研究。回顾性分析2021年4月至2024年12月于湖南省儿童医院接受男性性别重建尿道成形术的DSD患儿临床资料,统计术后并发症情况,采用单因素分析筛选出相关因素(P＜0.20),并纳入多因素Logistic回归模型以确定独立危险因素。通过受试者操作特征(receiver operating characteristic,ROC)曲线确定尿道缺损长度预测术后并发症的最佳截断值。结果 共纳入60例患儿,手术成功41例;术后发生并发症19例(31.7%),包括经皮尿道瘘6例、尿道口狭窄2例、吻合口狭窄2例、尿道憩室1例、尿道狭窄合并尿道憩室4例、切口感染4例。单因素分析显示,仅尿道缺损长度与术后并发症之间具有相关性(Z=-2.840,P=0.005),年龄、龟头宽度、性腺类型、染色体核型等因素与并发症之间无相关性(P＞0.05)。多因素Logistic回归分析证实,尿道缺损长度是术后并发症的独立危险因素(OR=1.865,95%CI:1.222~2.848,P=0.004)。ROC曲线分析显示,尿道缺损长度预测术后并发症的曲线下面积(area under curve,AUC)为0.729(95%CI:0.578~0.881,P=0.005),最佳截断值为4.90 cm,灵敏度为0.684,特异度为0.829,约登指数为0.513;结合临床实践,确定5.00 cm为临床适用临界值。结论 尿道缺损长度是性发育异常患儿男性性别重建尿道成形术后并发症的独立危险因素。当尿道缺损长度≥ 5.0 cm时,术后发生并发症的风险显著升高。临床应将尿道缺损长度作为核心评估指标,针对高危患儿制定个体化手术方案,同时加强围手术期管理,以改善预后。
- Abstract:
- Objective To explore the risk factors for postoperative complications after urethroplasty in children with disorders of sex development (DSD) after male gender reassignment and provide references for optimizing clinical management strategies and lowering the incidence of complications. Methods The relevant clinical data were retrospectively reviewed for 60 DSD children undergoing urethroplasty for male gender reassignment from April 2021 to December 2024.The incidence of postoperative complications was statistically summarized.Univariate analysis was used for screening the relevant factors (P<0.20).And screened factors were included into multivariate Logistic regression model for identifying independent risk factors.The receiver operating characteristic (ROC) curve was applied for determining the optimal cut-off value of urethral defect length for predicting postoperative complications. Results Postoperative complications occurred in 19 cases.Surgical success was achieved in 41 cases with a complication incidence of 31.7%.The major types of complications included fistula (n=6),meatal stenosis (n=2),anastomotic stenosis (n=2),urethral diverticulum (n=1),urethral stenosis combined with urethral diverticulum (n=4) and incision infection (n=4).Univariate analysis indicated that urethral defect length alone was significantly correlated with postoperative complications (Z=-2.840,P=0.005).No significant correlations existed among age,glanular width,gonadal type,karyotype or the occurrence of complications (all P>0.05).Multivariate Logistic regression analysis confirmed that urethral defect length was an independent risk factor for postoperative complications (OR=1.865,95%CI:1.222-2.848,P=0.004).Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of urethral defect length for predicting postoperative complications was 0.729 (95%CI:0.578-0.881,P=0.005) with an optimal cut-off value of 4.90 cm,a sensitivity of 0.684,a specificity of 0.829 and a Youden index of 0.513.In conjunctions with comprehensive clinical practices,5.00 cm was determined as a clinically applicable critical value. Conclusion Urethral defect length is an independent risk factor for postoperative complications of urethroplasty in DSD children after male gender reassignment.The risk of postoperative complications spikes greatly when urethral defect length is ≥5.0 cm.Clinically,urethral defect length should be regarded as a core evaluation indicator.Individualized surgical protocols and enhanced perioperative management should be formulated for high-risk children for better outcomes.
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备注/Memo
收稿日期:2026-3-28。
基金项目:国家临床重点专科培育项目-泌尿外科
通讯作者:赵夭望,Email:yw508@sina.com