尿道板纵切卷管尿道成形术后阴茎头裂开的相关危险因素分析

Risk factors of glan dehiscence after tubularized incised plate urethroplasty hypospadias repair

目的 探讨影响尿道下裂行尿道板纵切卷管尿道成形术(T IP)术后阴茎头裂开的相关危险因素.方法 收集2017年11月至2018年9月77例行T IP术式的尿道下裂患儿的临床资料,均为初次接受手术治疗.术后随访6~15个月,统计阴茎头裂开的发生率,分析阴茎头裂开的发生与患儿年龄、阴茎头直径、尿道板宽度、修复尿道长度、是否行背侧白膜折叠、成形后冠状沟至尿道外口距离、尿管型号的关系.结果 77例T IP术后患儿共出现阴茎头裂开10例(13.0%).统计学分析显示阴茎头裂开的发生与阴茎头直径、成形后冠状沟至尿道外口距离、尿管型号显著相关(均P<0.05).结论 阴茎头裂开是T IP尿道成形术后的主要并发症,处理具有一定难度,阴茎头直径、成形后冠状沟至尿道外口距离、尿管型号是影响阴茎头裂开发生的危险因素.因此T IP术中成形阴茎头时除了要注意充分游离阴茎头翼瓣,还要注意成形的冠口距大于4.5 mm更安全,留置6Fr尿管也能有效减少阴茎头裂开的发生.

Objective To explore the risk factors of glan dehiscence after TIP repairing in hypospadias children .Methods This retrospective study involved 77 consecutive hypospadias children undergoing TIP repair from November 2017 to September 2018 .All patients were followed up for 6-15 months .The relevant clinical data collected included age , glan width , urethral plate width pre-incision , neourethra length ,distance between meatus and corona ,type of catheter and whether dorsal plication or not . Independent t test ,chi-square test and logistic regression were performed for evaluating the risk factors of glan dehiscence .Results Glan dehiscence occurred in 10 (13 .0% ) patients .Our result indicated significant associations existed between group with glan dehiscence and group without glan dehiscence with respects to glan width ,distance between meatus and corona and type of catheter (all P<0 .05 ) .Conclusions Glan dehiscence is the most common complication after TIP hypospadias repair .Glan width ,distance between meatus and corona and type of catheter were obviously correlated with the development of glan dehiscence .A more extensive glans mobilization with >4 .5 mm distance between meatus and corona and 6Fr catheter regardless of age helps to minimize the occurrence of glan dehiscence .