"策略造瘘"技术在治疗复杂尿道下裂中的并发症研究

The complications of strategic urethrostomy in the treatment of complicated hypospadias

目的探讨"策略造瘘"技术治疗复杂尿道下裂的并发症情况。方法回顾性分析我院2016年1月至2018年8月收治的165例复杂尿道下裂患者的临床资料,根据患者采用的不同手术方式,分为一期手术组、Bracka分期手术组及"策略造瘘"组。一期手术组86例,中位年龄26个月(6~283个月),中位尿道缺损长度3.0 cm(2.0~10.0 cm);Bracka分期手术组49例,中位年龄24个月(8~241个月),中位尿道缺损长度4.0 cm(2.5~10.0 cm);"策略造瘘"组30例,中位年龄28个月(12~210个月),中位尿道缺损长度3.8 cm(2.0~11.0 cm),3组手术年龄及尿道缺损长度差异均无统计学意义(P>0.05)。一期手术组采用游离包皮内板或口腔黏膜与阴茎带蒂皮瓣耦合成形尿道;Bracka分期手术组采用Bracka分期手术方法;"策略造瘘"组Ⅰ期尿道成形手术同一期手术组,但保留近端尿道口不予关闭,6个月后Ⅱ期行近端尿道口关闭。分析3组术后尿道狭窄、尿道瘘及尿道憩室发生率等差异。结果术后随访(20.0±5.3)个月(3~32个月),一期手术组尿道狭窄发生率为22.0%(19/86),Bracka分期手术组为24.5%(12/49),"策略造瘘"组为3.3%(1/30),"策略造瘘"组的尿道狭窄发生率明显低于一期手术组(P=0.023)和Bracka分期手术组(P=0.032)。一期手术组尿道瘘发生率为8.1%(7/86),Bracka分期手术组为8.2%(4/49),"策略造瘘"组为0,3组间比较差异均无统计学意义(P>0.05)。一期手术组尿道憩室发生率为12.8%(11/86),Bracka分期手术组为6.1%(3/49),"策略造瘘"组为0,3组间比较差异均无统计学意义(P>0.05)。结论"策略造瘘"技术治疗复杂尿道下裂可有效降低术后尿道狭窄的发生率,具有良好的临床应用价值。

Objective To evaluate if strategic urethrostomy could reduce complications in complicated hypospadias repair.Methods From January 2016 to August 2018,165 patients of complicated hypospadias were reviewed according to inclusion criteria.They were divided into three groups of one-stage repair(group A,n=86),two-stage repair using Bracka procedure(group B,n=49)and strategic urethrostomy(group C,n=30).The median age was 26 months in group A,24 months in group B and 28 months in group C.The median length of urethral defect was 3.0(2.0-10.0)cm,4.0(2.5-10.0)cm and 3.8(2.5-11.0)cm in the different three groups,respectively.No difference showed in age or length of urethral defect among 3 groups.Three groups were compared with rates of urethral fistula,urethral stricture and urethral diverticulum.Results After average of 20.0 months follow-up,the urethral stricture incidence of group C[3.3%(1/30)]was significantly lower than that of group A[22.0%(19/86),P=0.023]and group B[24.5%(12/49),P=0.032].The complications were found in 7 patients with urethral fistula and 11 patients with urethral diverticulum in group A,4 patients with urethral fistula and 3 patients with urethral diverticulum in group B,none patient with urethral fistula nor urethral diverticulum in group C,respectively.The incidence of urethral fistula was 8.1%(7/86),8.2%(4/49)and 0 in the three groups,and the rate of urethral diverticulum was 12.8%(11/86),6.1%(3/49)and 0,respectively.None difference was shown neither in the incidence of urethral fistula nor urethral diverticulum among the three groups(P>0.05).Conclusions Strategic urethrostomy is a novel and effective method for complicated hypospadias repair.Application of strategic urethrostomy can significantly decrease urethral stricture and improve success rate in complicated hypospadias repair.