Tian Guangchao,Fan Yingzhong,Yuan Sitong,et al.Analysis of influencing factors of anastomotic stricture after Duckett operation for hypospadias[J].Journal of Clinical Pediatric Surgery,2022,21(05):445-451.[doi:10.3760/cma.j.cn101785-202110007-009]
尿道下裂Duckett术后并发吻合口狭窄的相关因素分析
- Title:
- Analysis of influencing factors of anastomotic stricture after Duckett operation for hypospadias
- Keywords:
- Hypospadias/SU; Hypospadias/CO; Surgical Stomas; Constriction; Pathologic; Urethral Stricture; Treatment Outcome; Comparative Study
- 摘要:
- 目的 探讨尿道下裂Duckett一期尿道成形术后尿道吻合口狭窄的相关因素。方法 回顾性分析2019年1月至2021年1月郑州大学第一附属医院收治的156例伴明显阴茎下弯的阴茎体型尿道下裂、且行Duckett一期尿道成形术患儿的临床资料,根据术后是否并发尿道吻合口狭窄分为狭窄组和非狭窄组。收集两组年龄、体重、手术时间、长短斜面尿道吻合方法、成形尿道长度、拔除尿管时间、拆除阴茎敷料时间、并发尿道瘘以及存在泌尿系统合并症情况,分析术后尿道吻合口狭窄的可能相关因素。结果 156例患儿中尿道下裂Duckett一期尿道成形术后发生吻合口狭窄29例(29/156,18.59%,狭窄组),无吻合口狭窄127例(127/156,81.41%,非狭窄组)。经单因素分析,与无狭窄组相比,狭窄组行长斜面尿道吻合例数明显较少[31.0%(9/29)比51.2%(65/127),χ2=3.843,P=0.05],术后尿道瘘的发生率明显较高[62.1%(18/29)比19.7%(25/127),χ2=21.241,P<0.001],差异有统计学意义。多因素分析结果显示,导致术后吻合口狭窄的相关因素为:斜面尿道吻合方法(P=0.022)、手术后并发尿道瘘(P<0.001)。29例尿道吻合口狭窄患儿均于全麻下行尿道扩张术,术中留置8~10Fr导尿管,并于尿道扩张术后1个月拔除;16例无再发排尿困难;12例拔除导尿管后2~3 d排尿困难再发,予全麻下切开狭窄环并行狭窄处近端造口术,术后6~10个月经瘘口修补后治愈;1例拔除导尿管后再发排尿困难患儿,经狭窄处切开并造口后半年修补人工造瘘口,随后排尿困难再发,予二次尿道成形后,于阴茎中部发现针尖状瘘口,半年后再次行瘘口修补术治愈。术后并发尿道瘘43例,其中40例于术后6~10个月行尿道瘘修补术治愈,3例经2次尿道瘘修补术治愈。结论 长或短斜面尿道吻合方法是Duckett一期尿道成形术后吻合口狭窄的独立相关因素,长斜面吻合法可有效减少术后尿道吻合口狭窄的发生。
- Abstract:
- Objective To explore the factors associated with stenosis of old and new urethral anastomo- sis after one-stage Duckett’s urethroplasty for hypospadias. Methods From January 2019 to January 2021,156 children of hypospadias with marked penile curvature were retrospectively recruited as study group. They were divided into two groups of stenosis and non-stenosis according to whether or not postoperative urethral anasto- motic stricture was complicated. The suspected factors associated with postoperative urethral anastomotic stric- ture included long/short bevel urethral anastomosis method, age, weight, operative duration, length of formed u- rethra, removal time of catheter, removal time of penile dressing, concomitant urethral fistula & urinary system comorbidity. Results Twenty-nine cases (29/156, 18. 59%) of anastomotic stricture occurred after urethro- plasty for hypospadias. Univariate analysis revealed that fewer cases of long-bevel urethral anastomosis were per formed in stenosis group[(n=9, 31. 0%) versus (n=65, 51. 2%), χ2=3. 843, P=0. 05] and there was a significantly higher incidence of postoperative urethral fistula[(n=18,62. 1%) versus (n=25,19. 7%), χ2=21. 241, P < 0. 001]. As compared with non-stenosis group, there was statistically significant difference. After multifactorial analysis, the factors associated with postoperative anastomotic strictures were long/short bevel ure- thral anastomosis method (P=0. 022) and postoperative complications of urethral fistula (P < 0. 001). Ure- thral dilation was performed under general anesthesia for urethral anastomotic stricture (n=29). An 8-10 Fr urethral catheter was inserted intraoperatively and removed at Month 1. Recurrent dysuria was absent (n=16) and present (n=12) at Days 2-3 after removing catheter. For the latter, ring incision with proximal anastomo- sis was performed under general anesthesia. Fistula was repaired at Months 6-10. In one child of recurrent dys- uria after catheter removal, artificial fistula was repaired 6 months after stenosis incising. During secondary ure- throplasty for recurrent dysuria, a needle-tip fistula in middle penis was cured at Month 6. Forty-three cases were complicated by postoperative urethral fistula and 40 cases cured after returning for urethral fistula repair at Months 6-10 months and 3 cases of urethral fistula were repaired. Conclusion After one-stage Duckett’s urethroplasty, long/short bevel urethral anastomosis is an independent factor of anastomotic stricture and long- bevel urethral anastomosis can effectively reduce the occurrence of postoperative anastomotic stricture.
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备注/Memo
收稿日期:2021-10-5。
基金项目:河南省联合重点基金项目（SBGJ202002042）
通讯作者:范应中,Email:fanyingzhong2@163.com