改良尿道板纵切卷管法在治疗小儿尿道下裂中的应用价值分析

Application value analysis of modified tubulaxized incised plate urethroplasty in the treatment of hypospadias in children

目的探讨改良尿道板纵切卷管法在治疗小儿尿道下裂中的应用价值。方法选取2014年3月~2016年3月在我院外科治疗的82例小儿尿道下裂患儿作为研究对象,按照随机数字表法将其分为两组,每组各41例。对照组患者采用传统手术方法治疗,观察组患者采用改良尿道板纵切卷管法治疗。比较两组患者的治疗效果、并发症发生情况,记录观察组患儿的术后尿瘘发生率。结果术后随访6~15个月,观察组患者的治疗总有效率为97.56%,明显高于对照组的85.37%,差异有统计学意义(P<0.05),患儿阴茎形状正常,尿道开口正位,排尿通畅,阴茎无弯曲。术后,观察组患者尿瘘、尿道狭窄、感染等并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。观察组患儿的阴茎阴囊型的尿瘘发生率最高,其次为阴茎体型,冠状沟型未发生尿瘘,阴茎体型、冠状沟型和阴茎阴囊型术后尿瘘的发生率比较,差异有统计学意义(P<0.05)。尿瘘者行尿瘘修补术后痊愈,尿道狭窄者经尿道扩张术后痊愈。结论改良尿道板纵切卷管法在治疗小儿尿道下裂中有良好的应用价值,能提高一次手术成功率,降低术后并发症和二次手术的概率,且能加快患儿术后恢复,具有积极的临床意义。

Objective To investigate the application value of modified tubularized incised plate （TIP） urethroplasty in the treatment of hypospadias in children.Methods Altogether 82 cases of pediatric hypospadias who accepted surgical treatment in our hospital from March 2014 to March 2016 were selected as subjects and were randomly divided into two groups according to the random number table method,41 cases in each group.The traditional surgical method was used in the control group;while,the observation group were treated with modified TIP urethroplasty.The surgical effectiveness and complications of patients between two groups were compared,the incidence of postoperative urinary fistula was recorded in the observation group.Results The total effective rate of patients in the observation group of postoperative follow-up 6- 15 months was 97.56%,which was significantly higher than the 85.37% in the control group,and the difference was statistically significant （P〈0.05）,the penis shape of patients were normal with right urethral opening position,smooth urination and no penile curvature.After the operation,the incidence of urinary fistula,urethral stricture and infection in the observation group were significantly lower than those in the control group,and the differences were statistically significant （P〈0.05）. Penis scrotal type has the highest incidence of urinary fistula of patients in the observation group,followed by the penis size type,coronary ditch type without urinary fistula.The incidence of urinary fistula in the penis size type,coronary sulcus type and penis scrotal type were compared,and the difference was statistically significant （P〈0.05）.The patients with uri- nary fistula underwent fistulous neoplasty and were recovered,and patients with urinary tract stenosis were treated with urethral dilatation and recovered.Conclusion The modified TIP urethroplasty has good application value in the treatment of children with hypospadias,can improve the success rate of operation,reduce the risk of postoperative complications and reoperations,and can accelerate the postoperative recovery in children,which has positive clinical significance.