留置尿道支架管的尿道下裂术后非计划提前拔导尿管的疗效分析

The effect of unplanned urinary catheter removal ahead of schedule after hypospadias operation indwelling urethral stent

目的分析留置尿道支架管的尿道下裂术后非计划提前拔尿管的治疗效果。方法回顾性分析2013年7月至2019年4月在本院进行尿道下裂手术并在术后留置尿道支架管患儿的临床资料,根据手术方法和是否提前拔导尿管分成A组(Snodgrass术式提前拔尿管组)、B组(Snodgrass术式正常拔尿管组)、C组(分期手术提前拔尿管组)及D组(分期手术正常拔尿管组),比较各组的手术效果。结果A组11例,术后导尿时间(5.32±1.25)d,尿瘘6例,占54.55%;B组52例,术后导尿时间(10.56±0.12)d,尿瘘6例,占11.53%;C组37例,术后导尿时间(5.13±1.74)d,尿瘘4例,占10.81%;D组215例,术后导尿时间(10.16±0.08)d,尿瘘19例,占8.84%。各组均未发现其他并发症,A组尿瘘发生率较其余3组明显增高,其余3组尿瘘发生率差异无统计学意义。结论在留置尿道支架管的情况下,提前拔尿管,分期的尿道下裂手术不影响手术效果,Snodgrass术式则会增加尿瘘的机会。

Objective To analyze the effect of unplanned urinary catheter removal ahead of schedule after hypospadias operation indwelling urethral stent.Methods Retrospective analysis was performed for clinical data of children after hypospadias surgery indwelling urethral stent from July 2013 to April 2019.The children were divided into 4 groups according to the surgical methods and whether the urinary catheter was removed in advance:group A(Snodgrass surgery and urinary catheter removal in advance),group B(Snodgrass surgery and normal urinary catheter removal),group C(staged surgery and urinary catheter removal in advance),and group D(staged surgery and normal urinary catheter removal).Their effects were compared.Results There were 11 cases in group A,with the average postoperative catheterization time of(5.32±1.25)days,among whom there were 6 cases of urinary fistula(54.55%).There were 52 cases in group B,with the average postoperative catheterization time of(10.56±0.12)days,among whom there were 6 cases of urinary fistula(11.53%).There were 37 cases in group C,with the average postoperative catheterization time of(5.13±1.74)days,among whom there were 4 cases of urinary fistula(10.81%).There were 215 cases in group D,with the average postoperative catheterization time of(10.16±0.08)days,among whom there were 19 cases of urinary fistula(8.84%).No other complications were found in each group.The urinary fistula rate in group A was significantly higher than that in other three groups,no statistically significant difference in urinary fistula rate among the other three groups.Conclusion In the cases of indwelling urethral stent,urinary catheter removal in advance does not affect the effect of staged hypospadias surgery,but increases the risk of urinary fistula in Snodgrass surgery.