近端与远端尿道下裂修复术中新尿道不同覆盖物术后并发症

A Comparative Study on Postoperative Complications of Different Urethral Coverings during the Repair of Proximal and Distal Hypospadias

目的研究近端与远端尿道下裂修复中新尿道不同覆盖物对术后并发症的影响。方法回顾性分析昆明医科大学第一附属医院泌尿外科2012年1月至2018年12月收治尿道下裂患儿169例,均予以TIP术修复重建尿道,依据有无额外尿道覆盖分为无覆盖组(n=25)和额外覆盖组(n=144),根据术中观察瘘口位置分为近端尿道下裂(n=119)和远端尿道下裂(n=50),其中额外覆盖组根据不同尿道覆盖物分为鞘膜组(n=84)、带蒂阴茎背侧筋膜覆盖组(n=40)和周围组织筋膜组(n=20)。结果 169例患者中,22例出现术后并发症,发生率为13.02%。其中无覆盖组出现并发症发生率24%(6/25),覆盖组出现并发症发生率11.11%(16/144),差异无统计学意义(P=0.077),覆盖组中尿瘘发生率为4.86%,无覆盖组尿瘘发生率为24%,差异有统计学意义(P=0.004)。结论近端及中段的尿道下裂,睾丸鞘膜则是一种较好的覆盖物。对于远端尿道下裂患者来说,带蒂阴茎腹侧筋膜瓣可以更好地对尿道进行覆盖,降低术后尿瘘的风险。

Objective To retrospectively study the effect of different coverings of the new urethra in the repair of proximal and distal hypospadias on postoperative complications. Methods A retrospective analysis of 169 children with hypospadias admitted to the Department of Urology of theFirst Affiliated Hospital of Kunming Medical University from January 2012 to December 2018 was performed. TIP suture repair urethra reconstruction was performed in all the cases. They were divided intoan unmulched group(n = 25) and anadditional cover group(n = 144)according to whether there was any additional urethra coverage.They were divided into a proximal hypospadias group(n = 119) and a distal hypospadias group(n = 50)according to the intraoperative fistula location.They were divided into a scabbard film group(n = 84), a ventrolateral fascia pedicle penis cover group(n = 14) and a surrounding tissue fascia group(n = 20)according to different urethra mulch. Results Among the169 patients, 22 had postoperative complications, with an incidence of 13.02%. The incidence of complications in the non-coverage group was 24%(6/25) and 11.11%(16/144) in the coverage group, with no statistically significant difference(P = 0.077). The incidence of urinary fistula was 4.86% in the coverage group and 24% in the non-coverage group, with statistically significant difference(P = 0.004). Conclusion The sheath of testis is a good covering for hypospadias proximal and midsection. For patients with distal hypospadias,pedicled penile ventral fascial flap provides better the coverage of the urethra and reduces the risk of postoperative urinary fistula.