围术期处理对尿道下裂尿道成形术后尿瘘和尿道狭窄发生的影响

Effects of perioperative treatments on incidence of urinary fistula and urethrostenosis after urethroplasty for hypospadias

目的 探讨围术期处理对尿道成形术后尿瘘和尿道狭窄的影响。方法 回顾性分析234例中段型尿道下裂患儿的一般临床资料及围术期处理情况,其中104例行Snodgrass手术,37例行Onlay手术,83例行Duckett手术。通过logistic回归分析影响尿道下裂术后尿瘘发生的围术期处理因素。将行不同术式的患儿根据尿管拔除时间进行分组,比较不同尿管留置时间组尿道狭窄的发生率。结果 234例病例中术后发生尿瘘43例（18.4%）,尿道狭窄44例（18.8%）。术后第1次换药时间〉3 d及拆除包扎时间≤3 d者尿道下裂术后尿瘘发生风险的较高（P〈0.05）。Duckett术后留置尿管延时组尿道狭窄发生率为14.3%,低于常规留置尿管组的33.3%（P〈0.05）,Snodgrass和Onlay术后不同尿管留置时间组间尿道狭窄发生率比较,差异无统计学意义（P〉0.05）。结论 术后尽早更换敷料并适当延长包扎时间,可以减少尿道下裂术后尿瘘的发生;Duckett术后延长留置尿管至术后21~28 d可以减少尿道狭窄的发生。

Objective To investigate the effects of perioperative treatments on the incidence of urinary fistula and urethrostenosis after urethroplasty for hypospadias. Methods The general clinical data and perioperative treatments of 234 children with middle-type hypospadias were retrospectively analyzed. Snodgrass procedure was performed in 104 cases, Onlay procedure in 37 cases and Duckett procedure in 83 cases. The perioperative treatments influencing the incidence of urinary fistula after surgery for hypospadias were analyzed using logistic regression analysis. The children undergoing different surgical procedures were grouped according to the time for removing the urinary catheter, then the incidences of urethrostenosis were compared between groups with different time for indwelling urinary catheter. Results Of 234 cases,urinary fistula occurred in 43 cases（ 18.4% ） ,and urethrostenosis in 44 cases（ 18.8% ）. The risk for the occurrence of urinary fistula after surgery was higher in the children with the first time for changing dressing 〉 3 days and the time for enswathe removal ~〈3 days（P 〈0.05）. The incidence of urethrostenosis in the delayed group was 14.3% after Duckett procedure, and was lower than that in the routine group（33.3% ,P 〈0.05）. There was no significant difference in the incidence of urethrostenosis between groups with different time for indwelling urinary catheter after Snodgrass or Onlay procedure（P 〉 0.05）. Conclusion Changing dressing as soon as possible after surgery and prolonging wound exposure time may reduce the occurrence of urinary fistula after urethroplasty for urethroplasty. After Duckett procedure,indwelling urinary catheter for postoperative 21 -28 days may reduce the incidence of urethrostenosis.