儿童尿道下裂TIP手术后近期尿流率变化研究

Variation tendency of urinary flow after tubularized incised plate urethroplasty in children with hypospadias

目的探讨尿道下裂患儿尿道板纵切卷管尿道成形术(tubularized incised plate urethroplasty,TIP手术)术后尿流率的变化,为临床治疗提供依据。方法收集2019年1月至12月在深圳市儿童医院行TIP手术的尿道下裂病例,分别于术前及术后1个月、3个月、6个月、1年行尿流率测定,分析尿流率变化。同时收集180例正常男童的尿流率,作为正常对照组。最大尿流率低于正常对照组均数的2个标准差定义为梗阻尿流。结果共有92例尿道下裂患儿纳入本研究,术前最大尿流率为(10.4±4.3)mL/s,术后1个月为(5.6±2.4)mL/s,术后3个月为(4.9±2.2)mL/s,术后6个月为(7.0±2.5)mL/s,术后1年为(8.1±2.4)mL/s。尿道下裂TIP手术后梗阻型尿流于后期逐渐减少,尿道梗阻减轻。与正常对照组儿童最大尿流率比较,尿道下裂患儿术前及术后不同时段尿流率均低于正常男童。结论尿道下裂患儿行TIP手术后尿流率较术前下降,手术后3个月尿流率下降至最低,6个月以后尿流率逐渐升高。尿道下裂TIP手术后梗阻型尿流常见,若无临床症状,无需治疗,大部分可自行好转。

Objective To explore variation tendency of urinary flow after tubularized incised plate(TIP)urethroplasty in children with hypospadias.Methods Retrospective review was conducted for 92 boys with hypospadias undergoing TIP urethroplasty from January 2019 to December 2019.Uroflowmetry was performed at Month 1/3/6/12 preoperatively to examine the variation of urinary flow.Also the data of urinary flow were collected from 180 normal boys as a control group.Obstructive urinary flow was present if maximal urinary flow(Qmax)dropped by 2 standard deviation lower than normal.Results Preoperative Qmax was(10.4±4.3)mL/s and postoperative Qmax(5.6±6.4),(4.9±9.2),(7.0±0.5)and(8.1±1.4)ml/s at Month 1/3/6/12.Obstructive flow was relieved in late stage after TIP urethroplasty.However,preoperative and postoperative urinary flows were lower in hypospadiacs than that in normal boys.Conclusion Urinary flow declines after TIP urethroplasty in hypospadiacs.It drops to the lowest level at Month 3 post-operation and then rises.Unless symptomatic,a conservative approach is preferable.