影响尿道下裂患儿手术年龄的相关因素分析

The timing factors associated with urethroplasty in hypospadias population

目的分析尿道下裂患儿临床特点与手术年龄的关系，探索影响尿道下裂患儿手术年龄的相关因素。方法回顾性分析郑州大学第一附属医院2011年1月至2016年12月接受手术治疗的尿道下裂患儿。收集患儿的人口统计学数据、尿道下裂严重程度、合并症、手术年龄及其他因素等资料。对影响尿道下裂手术年龄相关因素进行t检验，P〈0．05为差异有统计学意义。结果共有1051例尿道下裂患儿被纳入本研究，其中轻度尿道下裂268例（25．5％），中度尿道下裂525例（50．0％），重度尿道下裂258例（24．5％）。单纯尿道下裂946例（90．0％），具有合并症105例（10．O％）。平均手术年龄5．3岁，66．22％的患儿于3岁后行手术治疗，4．09％的患儿于18岁后行手术治疗。经统计学分析提示：有无医疗保险、家庭收入及民族对手术年龄无影响（P〉0．05）。尿道下裂严重程度（t=28．10，P=0．000）、有无合并症（t=64．17，P=0．000）、城乡差别（t=7．49，P=0．000）、父母文化程度（t=36．90，P=0．000）及咨询专业小儿泌尿外科医师治疗意见的时间（t=5．00，P=0．000）均明显影响手术年龄，差异均有统计意义。结论尿道下裂严重程度、有无合并症、城乡差别、父母文化程度及咨询专业小儿泌尿外科医师治疗意见的时间，均明显影响尿道下裂患儿的手术年龄，对患儿监护人及临床医师进行尿道下裂知识的普及教育会提前尿道下裂的手术年龄。

Objective To analyze the relationship between clinical features and age of operation on children with hypospadias ,and to explore and determine the factors for hypospadias associated with age at surgery. Methods Retrospective study was conducted in children with hypospadias undergoing operation at the First Affiliated Hospital of Zhengzhou University between January 2011 to December 2016. The demographics, the degree of hypospadias, complica- tions, age at first urethroplasty and the other factors in patients were recorded, t - test was used to determine the factors associated with surgical timing and the difference was significant when P 〈 0.05. Results A total of 1 051 cases were included in the study. Among these patients with hypospadias 268 cases （25.5%） were of mild cases, 525 cases （50. 0% ） of moderate,and 258 cases（24.5% ） of severe. Nine hundred and forty - six cases（90.0% ） did not have complications ,while 105 cases（ 10. 0% ） had complications. The median age at first nrethroplasty was 5.3 years old and 66.22% of them were operated after 3 years, and 4.09% of them were after 18 years old. Insurance types, household income ,race did not influence with surgical timing statistically （P 〉 0.05 ）. Multivariate analysis showed that the several factors were significantly associated with time of surgery：the severity of hypospadias （t = 28.10, P = 0. 000 ）, with or without complications （ t = 64. 17, P = 0. 000 ） , urban - rural gap （ t = 7.49, P = 0. 000 ） , parental education level （ t = 36.90,P = 0. 000） and the age of receiving advice from pediatric surgeon （ t = 5.00, P = O. 000）. Conclusions The age of surgery in children with hypospadias were significantly affected by the severity of hypospadias, the presence of complications, differences between urban and rural areas, the degree of parental education, and the time of medical advice in the pediatric department of urology, and the education of hypospadias knowledge for children＇s parents and related medical personnel at the grass - roots level will advance the age of surgery in children with hypospadias.