双极电凝在尿道下裂手术中的应用

Application of bipolar electrocoagulation to hypospadias repair

目的总结双极电凝在尿道下裂手术中应用的经验。方法先天性尿道下裂280例,其中冠状沟型26例,阴茎体型142例,阴茎阴囊型80例,会阴型32例。年龄1～8岁,平均4岁。分为A、B两组:A组140例,术中不采用双极电凝,采用压迫法、结扎法止血;B组140例,术中采用双极电凝止血。所有患者均采用保留尿道板尿道成形或横形带蒂包皮瓣尿道成形。比较其止血纱布使用的块数,手术所需时间,术后敷料血痂情况及其并发症。结果术中未使用双极电凝组与使用双极电凝组其术中所用止血纱布块数为(7.67±0.96)块和(2.12±0.63)块,手术时间为(112.52±3.88)min和(95.83±2.25)min,术后敷料血痂数为3.65±0.70和0.91±0.37,两组各指标差异有统计学意义(P<0.01)。前者并发症尿瘘、尿道狭窄较后者增加。结论先天性尿道下裂患儿手术中采用双极电凝止血,术野清晰,手术操作方便,手术并发症少,值得推广。

Objective To improve the efficacy of hypospadias repair.Methods A total of 280 patients of hypospadias with a mean age of 4 years（range 1 to 8） were enrolled in.The hypospadias consisted of subcoronal meatus in 26,shaft of penis in 142,penoscrotum in 80 and perineal hypospadias in 32 cases,respectively.In Group A（n=140）,bleeding was controlled by means of oppression or ligation during the operation,but in Group B（n=140） bipolar electrocoagulation was applied as the bleeding control method.Results In Group A（without bipolar electrocoagulation） and Group B（with bipolar electrocoagulation）,number of gauze piece,number of blood crust under dressing,and operative time were（7.67±0.96） vs（2.12±0.63）,（3.65±0.70） vs（0.91±0.37） and（112.52±3.88） vs（95.83±2.25）,respectively.And the complications of fistula and urethral stricture were less in Group B than in Group A.Conclusion Bipolar electrocoagulation in hypospadias repair provides a good view field in the surgery and a good outcome with few complications.