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[1]范旭,杨屹..尿道下裂不同组织额外覆盖术后并发症的对比研究[J].临床小儿外科杂志,2018,17(08):571-576.
　Fan Xu,Yang Yi..Comparative study of postoperative complications for different tissues during hypospadias surgery[J].Journal of Clinical Pediatric Surgery,2018,17(08):571-576.

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尿道下裂不同组织额外覆盖术后并发症的对比研究

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第17卷期数: 2018年08期页码: 571-576 栏目: 专题讨论出版日期: 2018-08-28

Title:: Comparative study of postoperative complications for different tissues during hypospadias surgery

作者:: 范旭; 杨屹.; 中国医科大学附属盛京医院小儿泌尿外科

Author(s):: Fan Xu; Yang Yi.; Department of Pediatric Urology,Affiliated Shengjing Hospital,China Medical University,Shenyang 110000,China.

关键词:: 尿道下裂 ; 尿瘘 ; 外科皮瓣 ; 再手术 ; 对比研究

Keywords:: Hypospadias; Urinary Fistula; Surgical Flaps; Reoperation; Comparative Study

文献标志码:: A

摘要:: 目的　比较尿道下裂手术中有无额外覆盖及不同软组织覆盖并发症发生率的差异，为临床选择最佳额外覆盖材料提供参考依据。　方法　回顾性分析２０１４年１月至２０１６年１２月符合纳入和排除标准由本院收治的尿道下裂患儿１５０例，依据有无额外覆盖材料分为额外覆盖组（ｎ＝９０）和无额外覆盖组（ｎ＝６０）；根据术中探查尿道口位置分为近端型尿道下裂组（ｎ＝１１５）及远端型尿道下裂组（ｎ＝３５）；根据覆盖组织分为鞘膜覆盖组（ｎ＝３０）、肉膜覆盖组（ｎ＝４２）以及阴囊中隔筋膜覆盖组（ｎ＝１８）。　结果　额外覆盖组和无额外覆盖组首次手术的年龄、平均龟头直径、阴茎拉伸长度、阴茎脱套后腹曲角度、尿道缺损长度无统计学差异（Ｐ＞０．０５）。１５０例中，３５例术后出现并发症，发生率为２３．３３％。额外覆盖组并发症发生率为１３．３３％（１２／９０），无额外覆盖组并发症发生率为３８．３３％（２３／
６０），差异有统计学意义（ χ ２＝１２．５７８，Ｐ＝０．００１）；额外覆盖组尿道瘘发生率为８．８９％（８／９０），无额外覆盖组尿道瘘发生率为３３．３３％（２０／６０），差异有统计学意义（ χ ２＝１９．０３６，Ｐ＝０．００１）。１１５例近端尿道下裂中，其中７９例使用了额外覆盖材料，１０例（１２．６５％）术后发生了并发症，３６例未使用额外覆盖材料，１６例（４４．４４％）术后发生了并发症，差异存在统计学意义（ χ ２＝１４．２８，Ｐ＝０．０１）。同时，额外覆盖组尿道瘘发生率为７．５９％（６／７９），无额外覆盖组尿道瘘发生率为３６．１１％（１３／３６），差异有统计学意义（ χ ２＝１４．５８，Ｐ＝０．０１）。肉膜覆盖组并发症发生率为９．５２％（４／４２），睾丸鞘膜覆盖组并发症发生率为１０％（３／３０），阴囊中缝筋膜覆盖组并发症发生率为２７．７８％（５／１８），三组患儿术后并发症发生率无统计学差异（ χ ２＝４．０７，Ｐ＝０．１３）；肉膜覆盖组、睾丸鞘膜覆盖组和阴囊中缝筋膜覆盖组三组患儿术后尿道瘘的发生率分别为９．５２％、０．００％和２２．２２％，差异有统计学意义（ χ ２＝６．９０，Ｐ＝０．０３）。　结论　额外覆盖可有效降低尿道下裂术后并发症尤其是尿道瘘的发生率，和其他覆盖组织比较睾丸鞘膜可更有效的降低术后尿道瘘的发生率。

Abstract:: ObjectiveTo compare the differences of complication rates with additional coverage and select the optimal urethral covering material during hypospadias surgery.MethodsA retrospective study was conducted for 150 patients with hypospadics undergoing surgical repair from January 2014 to December 2016.They were divided into additional coverage (n=90) and uncovered (n=60) groups.According to intraoperative exploration of urethral orifice position,they were divided into proximal (n=115) and distal (n=35) hypospadias groups.And the additional coverage group was divided into tunica vaginalis (n=30),dartos flap (n=42) and midscrotalfasciocutaneous flap (n=18) groups.ResultsNo statistical difference existed in median age,mean glans diameter,penile traction length,penile curvature degree or urethral defect length between additional coverage and uncovered groups.And 35/150 cases had postoperative complications with a complication rate of 23.33%.The complication rate was 13.33% in additional coverage group and 38.33% in uncovered group.There was intergroup statistical difference (χ2=12.578,P=0.001).While the incidence of urethral fistula rate was 8.89%（8/90） in additional coverage group and 33.33%（20/60） in uncovered group.There was intergroup statistical difference (χ2=19.036,P=0.001).Among 115 proximal hypospadics,79 cases used additional covering materials,10 (12.65%) had postoperative complications,36 cases used no additional covering materials and 16 cases (44.44%) had postoperative complications.There was intergroup statistical difference (χ2=14.28,P=0.01).While 7.59% of proximal hypospadics had postoperative urethral fistula with additional covering materials,36.1% of proximal hypospadics had postoperative urethral fistula without additional covering materials (χ2=14.58,P=0.01).The complication rate was 9.52% in dartos flap group,10% in tunica vaginalis flap group and 27.78% in midscrotal fasciocutaneous flap group.No statistical difference existed among three groups (χ2=4.07,P=0.13).Urethral fistula was 9.52% in dartos flap group,0.00% in tunica vaginalis flap group and 22.22% in midscrotal fasciocutaneous flap group.Statistical differences existed among three groups (χ2=6.90,P=0.03).ConclusionAdditional coverage may effectively reduce the complication rate of hypospadias.As compared with other cover tissues,tunica vaginalis effectively lower the incidence of postoperative urethral fistula.

更新日期/Last Update: 2018-08-21