摘要
目的通过分析分期手术与一期手术的临床特点和疗效差异,总结重度尿道下裂的治疗经验。方法回顾性分析2005年9月-2011年7月重度尿道下裂92例,年龄8个月～23岁,中位年龄4.8岁。全组均为首次手术病例,其中分期手术32例,一期手术60例。比较2组阴茎阴囊转位情况、阴茎伸直前后尿道外口位置、尿道缺损长度、并发症、手术成功率。结果 2组阴茎阴囊转位的差异无统计学意义(P=0.303 9)。2组手术成功率的差异无统计学意义(P=0.796 1)。分期手术组阴茎伸直后尿道外口位于阴囊的比率高于一期手术组(P=0.022 8),分期手术组尿道缺损平均长度大于一期手术组(P=0.000 1),一期手术组尿道狭窄发生率高于分期手术组(P=0.044 1)。结论重度尿道下裂手术方式的选择必须在阴茎伸直以后才能决定。如果尿道缺损长度超过Duckett皮管和Duplay皮管总长度,应该选择分期手术。尽管分期手术与一期手术成功率没有明显差异,但是手术方式选择的失误将导致尿瘘或者尿道狭窄的高发生率。
Objective To summarize the clinical experiences about severe hypospadias by analyzing the clinical characteristics and the-rapeutic effectiveness of two - stage and one - stage operation. Methods Retrospective analysis on 92 cases of severe hypospadias from SOp. 2005 to Jul. 2011 was performed. All patients were first operation cases, from 8 months to 23 years old, the median age was 4 years old and 8 months. There were 32 cases of two - stage operation （ Snodgrass precedure ） ,60 cases of one - stage operation （ Duckett ＋ Duplay procedure）. Some projects had been compared on different procedure, such as the translocation of scrotum, the position of urinary meatus pre or post - straight,the lengths of urethral defects,the complication rate and the successful rate. Results The difference of the translocation of scrotum in the 2 groups was not statistically significant （P = 0. 303 9 ）. The successful rate in the 2 groups had no statistically significant difference （P = 0. 796 l ）. The rate of scrotal post-straight in two-stage group was higher than that in one-stage group（P =0. 022 8）. The length of ure-thral defect of two - stage group was longer than that in one - stage group（ P = 0. 000 1 ）. The rate of urethra stenosis in one - stage group was longer than that in two - stage group（ P = 0. 044 1 ）. Conclusions Which operation procedure should be chosen to treat severe hypospadias, the capital principle was that the position of urinary meatus post - straight. If the lengths of urethral defects were longer than that of Duckett flap and Duplay flap, two - stage procedure should be chosen. In spite of the successful rate in the 2 groups had no difference, but the fault of operation chosen should lead to higher incidence rate of urinary fistula or urethra stenosis.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2012年第20期1613-1615,共3页
Journal of Applied Clinical Pediatrics
基金
广西壮族自治区卫生厅计划课题资助(桂卫Z2011330)
关键词
尿道下裂
尿道成形术
分期手术
一期手术
hypospadias
urethroplasty
two - stage operation
one - stage operatit
