Liu Yu,Qin Daorui,Wang Xuejun,et al.Analysis of related factors of complications after tubularized incised plate for initial hypospadias: a single-center report of 309 cases[J].Journal of Clinical Pediatric Surgery,2020,19(12):1094-1099.[doi:10.3969/j.issn.1671-6353.2020.12.007]
初治尿道下裂TIP手术后并发症的相关因素分析:309例单中心研究
- Title:
- Analysis of related factors of complications after tubularized incised plate for initial hypospadias: a single-center report of 309 cases
- 分类号:
- R726.9;R697+.11;R695
- 摘要:
- 目的 回顾性分析接受尿道板纵切卷管尿道成形术（Snodgrass手术或TIP手术）治疗的初治尿道下裂患者的临床及随访资料，总结分析TIP手术后发生并发症的危险因素。方法 回顾性收集2010年9月至2014年11月于四川省人民医院小儿外科接受TIP手术治疗的患者，根据纳入排除标准共纳入309例初治尿道下裂患者，获取患者手术时的年龄、尿道下裂分型、阴茎弯曲程度、尿道成形长度、阴茎头宽度、覆盖材料、舟状沟宽度、卷管宽度、尿道板宽度及尿管型号等临床资料，通过多因素分析TIP手术后并发症的危险因素。结果 309例尿道下裂患者平均随访时间为4年。术后发生并发症的患者60例（19.4%），其中阴茎头裂开17例（5.5%），尿道瘘33例（10.7%），尿道狭窄9例（2.9%），术后残留弯曲3例（0.97%），尿道憩室1例（0.32%），其中3例同时发生阴茎头裂开和尿道瘘。单因素分析后将尿道板宽度、舟状沟宽度及卷管宽度纳入多因素Logistic回归分析，结果显示舟状沟宽度是影响术后发生并发症的独立危险因素（P<0.05），且舟状沟宽度与TIP手术后发生并发症的风险呈负相关（OR=0.73，P=0.011），即舟状沟宽度每增加1 mm发生术后并发症的风险降低27%。根据ROC曲线（AUC=0.611，P=0.008）计算出约登指数最大时（约登指数=0.18），其临界值为4.25 mm，舟状沟宽度<4.25 mm的患者发生术后并发症的风险是舟状沟宽度≥ 4.25 mm患者的2.082倍（OR=2.082，P=0.015）。结论 舟状沟宽度是初治尿道下裂TIP手术后并发症发生的重要影响因素，因此对于行TIP手术的患者应重点关注舟状沟宽度，尤其对于舟状沟宽度<4.25 mm的患者，不宜施行单纯的TIP手术。
- Abstract:
- Objective To retrospectively analyze the clinical and follow-up data of children with hypospadias undergoing initial urethroplasty with Snodgrass or tubularized incised plate (TIP) and summarize the risk factors for complications after TIP.Methods Between September 2010 and November 2014,retrospective analysis was performed for 309 TIP children.Operative age,degree of hypospadias parting,penile curvature,urethra length,head width,covering material,penile width of navicular groove,coil tube width widths of urethral and urine tube type were recorded for multi-variable Logistic regression analysis.Results During a mean follow-up period of 4 years,postoperative complications occurred in 60 children (19.4%),including penile head depravation (n=17,5.5%),urinary fistula (n=33,10.7%),urethral stricture (n=9,2.9%),postoperative residual flexion (n=3,0.97%) and urethral diverticulum (n=1,0.32%).And 3 cases of penile head depravation and urinary fistula occurred simultaneously.After single factor analysis,widths of urethral plate,navicular groove and roll tube were included into multi-variable Logistic regression analysis.Width of navicular groove was an independent risk factor for postoperative complications (P<0.05).And width of navicular groove and TIP were negatively correlated with the risk of postoperative complications (P=0.011,OR=0.73).Specifically 1 mm rise of width of navicular groove had a 27% lower risk of postoperative complications.According to the ROC curve (AUC=0.611,P=0.008),the threshold value of 4.25 mm was obtained at a maximal Jorden index (Jorden index=0.18).The risk of postoperative complications in children with width of anavicular groove<4.25 mm was 2.082 folds that in those with a larger width (P=0.015,OR=2.082).Conclusion Width of navicular groove is an important influencing factor of postoperative complications after an initial TIP for hypospadias.Therefore width of navicular groove should be stressed for children undergoing TIP,especially for those with width of navicular groove<4.25 mm.Performing TIP alone is not advisable.
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备注/Memo
收稿日期:2020-08-06。
基金项目:四川省卫生健康委员会（编号：150206）
通讯作者:唐耘熳,Email:tangyunman@126.com