摘要
目的探讨分期手术治疗重型尿道下裂的价值。方法回顾性分析2011年8月至2015年3月33例重型尿道下裂分期手术的临床效果及尿道功能的尿动力学评估资料，同时选取年龄相当的无尿道疾病住院患儿作为正常对照组进行对比分析。本组年龄2岁5个月～11岁，随访最长32个月。一期手术矫正下曲后按Barcat分型均为后型。二期手术术式主要有Duplay、Snodgrass、Thiersch，还有改良Koyanagi或Onlay。两期手术间隔8～16个月，平均12个月。成形尿道长度平均4．5cm。分别于术后1个月及6个月2个时段行尿流率检查，测量最大尿流率、排尿时间、排尿量、QC值，评估尿流曲线，并与正常对照组对比。按照Qmax低于正常对照组均数的2个标准差定义为梗阻尿流。结果本组术后均无阴茎弯曲，正位尿道口31例，尿道外口退缩2例；尿瘘8例（24．2％）；无尿道狭窄患儿。术后1个月时，梗阻型尿流和非梗阻型尿流分别占53．0%（9／17）和47．0％（8／17）；而术后6个月时段对应值为46．2％（6／13）和53．8％（7／13），比较构成比，差异无统计学意义。术后1个月时段梗阻型尿流曲线（平台曲线、不规则曲线）和非梗阻型尿流曲线构成比分别为76．5％（13／17）和23．5％（4／17），术后6个月时段则分别为76．9％（10／13）和23．1％（3／13）；正常对照组为10．6％（7／66）和89．4％（59／66）。术后2个时段梗阻型尿流曲线的比例均高于正常对照组，且差异有统计学意义（P〈0．05）；而术后2个时段比较差异无统计学意义。结论主动选择性分期手术修复重型尿道下裂，尿瘘发生率较高，但并发尿道狭窄风险极低；尿流率测定结果显示术后半年内尿道功能呈现功能性梗阻。
Objective To explore the complication rates and urinary functions in patients with proximal hypospadias after staged surgery. Methods Thirty-three patients of proximal hypospadias undergoing staged procedures and voiding volitionally were selected between August 2011 and March 2015. The mean age was 4 years. And the follow-up period was up to 32 months. The average length of reconstructed urethra was 4. 5 cm. The parameters of flow pattern, maximum （Qmax）, voiding time （VT）, voided volume and QC value were measured. compared with published values of normal controls. And the values were expressed as percentiles and The obstruction on uroflowmetry was judged as a presence of a plateau pattern and Qmax below two standard deviations （SD） below normal age mean. Results Among them, 31 cases had final glanular location of neomeatus without residual chordee or urethral stricture. And 8 cases （24. 2%） developed urethral fistula. Seventeen cases received an uroflowmetry test at 1 month and 13 cases stayed at 6 months. Uroflowmetry was obstructive in 9 cases （53%） at 1 month and 6 cases （46. 2%） at 6 months. An obstructive flow pattern was noted in 13/17 （76. 5%） versus 10/13 （76. 9%）. Conclusions Despite a high rate of urethrocutaneous fistula, there is a lower risk of urethral stricture. Also functional obstruction might occur at 6 months postoperation.
出处
《中华小儿外科杂志》
CSCD
2016年第12期924-927,共4页
Chinese Journal of Pediatric Surgery
关键词
尿道下裂
尿道成形术
并发症
尿流率
Hypospadias
Urethroplasty
Complications
Uroflowmetry
