尿道下裂成形术后并发症的临床分析

Clinical analysis of complications after urethroplasty in hypospadias

目的分析尿道下裂术后并发症及其相关因素,以利提高手术成功率。方法回顾2010年1—12月239例尿道下裂一期尿道成形术患儿的临床资料,统计手术成功率及并发症,并对其相关因素进行分析。结果 239例患儿中术后并发尿瘘41例(17.2%),尿道狭窄3例(1.3%),总治愈率为81.6%(195/239)。多因素相关分析显示,手术成功与手术方式关系显著(P=0.034),而与尿道下裂类型、手术者、患儿手术年龄无关(P>0.05)。χ2检验显示,Koyanagi术式、Snod-grass术式的手术成功率分别与Magpi术式、Mathieu术式、Onlay术式手术成功率比较,差异有统计学意义(P<0.05);其余各种术式手术成功率两两比较,差异无统计学意义(P>0.05)。结论尿瘘仍是尿道下裂成形术后最主要的并发症,根据尿道下裂严重程度选择合理的手术方式有利于提高手术成功率。

Objective To analyze the complications and related factors after urethroplasty in hypospadias patients,in or- der to improve the success rate of urethroplasty. Methods The clinical data of 239 patients with hypospadias treated from Jan- uary to December 2010 were reviewed and analyzed on the success rate of urethroplasty ,complications and related factors. Re- suits Complications developed in 44 cases including 41 cases （ 17.2% ） of urethrocutaneous fistula and 3 cases （ 1.3% ） of urethral stricture. The overall success rate was 81.6%（195/239）. The operation success was significantly associated with the types ofhy- pospadias, surgical modes and operators （P=0.034）, while had no relation with the severity of hypospadias, urologist and the op- eration age （P〉0.05）./7 test showed that the separate comparison of operation success rates of Koyanagi and Snodgrass with that of Magpi, Mathieu and Onlay had statistical significance （ P〈0.05 ） ; there was no statistical significance on the pairwise compari- son of the other kinds of operations. Conclusion Urethrocutaneous fistula is still the main complication after urethroplasty. Ra- tional select of the operation modes and experience accumulation and techniques improvement of surgeon are conducive to in- crease the operation success rate..