检索历史 清除

目的 探讨运用一期手术及分期手术治疗重度尿道下裂(阴茎伸直后尿道开口位于阴茎根部、阴茎阴囊交接部及会阴部)手术效果的差异.方法 回顾性分析首都医科大学附属北京儿童医院泌尿外科2009年1月至2013年12月收治的病历资料完善的重度尿道下裂患儿765例的临床资料.按手术方法不同分为一期手术组(650例)和分期手术组(115例).分析比较两组患儿手术年龄、尿道缺损长度及术后尿道瘘、尿道憩室、尿道狭窄发生率差异.结果 一期手术组650例平均初次手术年龄29月龄(7～130月龄),尿道缺损长度均值为4.01 cm(2.00～8.00 cm);分期手术组115例平均初次手术年龄34月龄(8～156月龄),尿道缺损长度均值为4.33cm(3.00～9.00cm),两组患儿手术年龄和尿道缺损长度差异均无统计学意义(P＞0.05).一期组术后总并发症发生率为30.5％(198/650),分期组为33.9％(39/115),组间比较,差异无统计学意义(x2=0.544,P＞0.05).一期组术后尿道瘘发生率为16.0％(104/650),分期组为31.3％(36/115),组间比较,差异有统计学意义(x2=15.307,P＜0.05).一期组术后尿道憩室发生率为14.0％(91/650),分期组为2.6％(3/115),组间比较,差异有统计学意义(x2=11.764,P＜0.05).一期组术后尿道狭窄发生率为7.5％(49/650),分期组为4.3％(5/115),组间比较,差异无统计学意义(x2=1.516,P＞0.05).结论 对于重度尿道下裂,一期手术和分期手术效果无明显差异,但是一期手术术后尿道瘘发生率较低,而分期手术术后尿道憩室发生率较低.

Objective To explore the difference of urethral complications between one-stage and twostage repair of severe hypospadias.Methods A total of 765 patients underwent repairing of severe hypospadias from January 2009 to December 2013.They were divided into two groups of one-stage repair (Duckett & Duckett plus Duplay) (A,n =650) and two-stage repair (B,n =115).Two groups were compared with regards to age,length of urethral defect,rate of urethral fistula,urethral diverticulum and urethral stricture.Results In group A,the mean age was 29(7-130) months and the mean length of urethral defect 4.01(2.00-8.00) cm;in group B,the mean age was 34(8-156) months and mean length of urethral defect 4.33(3.00-9.00) cm.No difference of statistic significance existed in age,length of urethral defect (P＞0.05,P＞0.05) or rate of urethral complications [group A 30.5％(198/650) vs group B 33.9％ (39/115),x2 =0.544,P＞0.05].Difference of statistic significance existed in rate of urethral fistula [group A 16.0％(104/650),group B 31.3％(36/115),x2 =15.307,P＜0.05] and rate of urethral diverticulum [group A 14.0％(91/650) vs group B 2.6％ (3/115),x2 =11.764,P＜0.05].There was no difference of statistic significance in rate of urethral stricture [group A 7.5％(49/650) vs group B 4.3％(5/115),x2 =1.516,P＞0.05].Conclusions For overall complications of severe hypospadias,there is no difference of statistic significance between one-stage and two-stage repairing.However,the rate of urethral fistula is lower after one-stage repair and the rate of urethral diverticulum tends to be lower after two-stage repair.