Li Changpei,Zhou Wei,Xia Fan,et al.Application of dorsal inlay urethroplasty with inner prepuce graft for hypospadias with narrow urethral plate: a clinical randomized controlled trial[J].Journal of Clinical Pediatric Surgery,2021,20(10):935-940.[doi:10.12260/lcxewkzz.2021.10.008]
包皮内板背嵌尿道成形术治疗尿道板狭窄尿道下裂的临床随机对照研究
- Title:
- Application of dorsal inlay urethroplasty with inner prepuce graft for hypospadias with narrow urethral plate: a clinical randomized controlled trial
- Keywords:
- Hypospadias/SU; Foreskin; Urethral Stricture/CO; Clinical Study
- 分类号:
- R695;R695.4;R726.9
- 摘要:
- 目的 探讨包皮内板背嵌尿道成形术（dorsal inlay graft urethroplasty，DIGU）在尿道板狭窄的尿道下裂患者中的应用效果。方法 前瞻性收集2016年6月至2018年6月在厦门市儿童医院接受手术治疗的78例尿道板狭窄的尿道下裂患者作为研究对象，依据不同治疗方法将其随机分为DIGU组（n=39）和TIP组（n=39），DIGU组采用尿道板纵切+包皮内板背嵌尿道成形术，TIP组采用尿道板纵切卷管尿道成形术（tubularized incised plate urethroplasty，TIP）。所有患者获6个月以上随访，收集所有患者阴茎外观和功能结果情况。比较两组手术时间，手术后尿道狭窄、尿瘘、尿道憩室等发生率，尿流率（完成如厕训练者），HOSE评分等情况。结果 所有患者顺利完成手术，在平均24.1个月的随访中，DIGU组和TIP组尿道狭窄等并发症的发生差异无统计学意义（P>0.05）；DIGU组手术时间长于TIP组[（95.91±10.80）min vs.（73.81±7.62）min，t=10.38，P<0.05]；DIGU组HOSE评分高于TIP组[（14.70±1.10）分vs.（13.43±1.09）分，t=5.27，P<0.05]；DIGU组的最大尿流率（Qmax）高于TIP组[（9.91±1.50）mL/s vs.（6.81±1.41）mL/s，t=8.04，P<0.05]。结论 在尿道板狭窄的尿道下裂治疗中，与TIP手术相比，DIGU手术尽管没有减少尿道狭窄等并发症的发生，且增加了手术时间，但有更好的阴茎外观评分和更好的排尿功能，可作为治疗尿道板狭窄尿道下裂的首选术式之一。
- Abstract:
- Objective To explore the efficacy of dorsal inlay urethroplasty (dorsal inlay graft urethroplasty, DIGU) with inner prepucegraft for hypospadias with narrow urethral plate.Methods A prospective study was conducted for 78 operated children with hypospadias from June 2016 to June 2018.According to different treatment methods, they were randomly divided into two groups of DIGU (n=39) and control (n=39).DIGU group underwent urethroplasty with longitudinal resection of urethral plate and dorsal urethroplasty with internal prepuce plate while control group had urethroplasty with longitudinal incision of urethral plate (tubularized incised plate, TIP).During a follow-up period of 6 months, the outcomes of penile appearance and function were observed.Operative duration, incidence of postoperative urethral stricture/diverticulum, urinary fistula, urinary flow rate (finishing toilet training) and HOSE score were recorded and compared between two groups.Results All operations were completed successfully.During an average follow-up period of 24.1 months, no significant inter-group difference existed in urethral stricture or other complications (P>0.05).Operative duration was longer in DIGU group than that in TIP group[(95.91±10.80) vs.(73.81±7.62) min, t=10.38, P<0.05].The HOSE score of DIGU group was higher than that of TIP group[(14.70±1.10) vs.(13.43±1.09), t=5.27, P<0.05].The maximal urinary flow rate (Qmax) was higher in DIGU group than that in TIP group[(9.91±1.50) vs.(6.81±1.41) ml/s, t=8.04, P<0.05].Conclusion Among children with hypospadias with a narrow urethral plate, as compared with TIP, DIGU fails to reduce the incidence of urethral stricture and operative duration is longer.However, DIGU offers a higher penile appearance score with better urination functions.Thus it may be employed as a first option for hypospadias with narrow urethral plate.
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备注/Memo
收稿日期:2020-09-17。
基金项目:厦门市儿童医院1125人才工程资助（编号：〔2020〕6号）；厦门市儿童医院青年科研基金项目资助（编号：CHP—2019—YRF—0020）
通讯作者:周维,Email:etyy6161@126.com