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(Q_(max))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。
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.
作者
李昌佩
周维
夏凡
章奇
杨墨文
陈燕星
毕允力
Li Changpei;Zhou Wei;Xia Fan;Zhang Qi;Yang Mowen;Chen Yanxing;Bi Yunli(Department of Urology,Xiamen's Children Hospital(Children's Hospital of Fudan University's Xiamen Branch),Xiamen 361006,China;Department of Urology,Children's Hospital of Fudan University,Shanghai 201102,China)
出处
《临床小儿外科杂志》
CAS
CSCD
2021年第10期935-940,共6页
Journal of Clinical Pediatric Surgery
基金
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)。
