尿道下裂术后复杂性尿道皮肤瘘的手术疗效及预后分析

The effect of surgical treatment of complex dermal-urethral fistula after hypospadias surgery and prognosis analysis

目的探讨尿道下裂手术后并发复杂性尿道皮肤瘘患者的手术治疗效果及预后情况。方法回顾性分析33例尿道下裂手术后并发复杂性尿道皮肤瘘患者和60例术后并发简单尿瘘的患者临床资料,分为复杂组和简单组。两组均予以对症术式治疗,对比两组1次手术成功率、再次手术成功率的差异,检测治疗前后尿动力学指标变化情况。结果 (1)简单组1次手术成功率为88.3%,与复杂组的84.8%比较差异无统计学意义(P>0.05);两组中1次手术失败者均接受2次手术,简单组2次手术均获得成功;复杂组成功4例,失败1例,失败的1例随后行第3次手术且成功治愈,两组在2次手术成功率比较上也无统计学差异(P>0.05)。(2)两组术后最大尿道关闭压(MUCP)、最大尿流率(Qmax)、平均尿流速等尿动力学指标均较术前明显提升(P<0.05),但两组间比较均无统计学差异(P>0.05)。结论对尿道下裂手术后并发复杂性尿道皮肤瘘的患者予以对症手术治疗,手术成功率高,术后尿动力学指标恢复效果理想,尿瘘复发风险较低,患者预后质量较高。

Objective To explore the effect of surgical treatment of patients with complex dermal-urethral fistula after hypospadias surgery and prognosis. Methoda A retrospective analysis of clinical data which contained 33 cases about patients with complex dermal-urethral fistula after hypospadias surgery and 60 cases of patients with postoperative simple urinary fistula. Respectively, they were divided into the complex group（n=33） and the simple group（n=60）. Two groups of patients were given symptomatic treatment. The success rate of surgery and the reoperation success rate difference of the two groups of patients were observed and compared. The changes of urinary dynamics indexes were detected before and after treatment. R^ulIs （1）There was no significant difference in the success rate of the simple group （88.3%） and the complex group （84.8%） （P 〉 0.05）; patients whose operation failed in the first time all received the second surgery. The second surgeries in the simple group were successful. Complex group success in 4 cases, failure in 1 cases. The failed patient followed by third surgery and successfully cured, there was no significant difference in the secondary surgical success rate（P 〉 0.05）.（2）There was no significant difference in the maximum urethral closure pressure （MUCP）, maximum flow rate （Qmax）, mean urinary flow rate and other indicators of urinary dynamics before and after surgery（P 〉 0.05）, but the results of the above indexes were significantly improved compared with the preoperative （P 〈 0.05）. Concluaion Giving patients with complex dermal-urethral fistula after hypospadias surgery symptomatic surgical treatment can make the success rate of operation high, recovery effect of postoperative urodynamie indices satisfying, urinary fistula recurrence risk lower, the quality of patients＂ prognosis higher.