骶管阻滞麻醉对尿道板纵切卷管法治疗尿道下裂术后并发症的影响

Impact of caudal regional anesthesia on complications after hypospadias repair with tubularised incised plate urethroplasty

目的探讨尿道板纵切卷管法(TIP)治疗尿道下裂术后并发症与骶管阻滞麻醉的关系。方法回顾性分析2017年6月至2019年6月在首都医科大学附属北京儿童医院修复的尿道下裂患儿125例临床资料,年龄12~75个月,美国麻醉医师协会分级为Ⅰ~Ⅱ级。按照尿道口位置分为远端型(86例)、近端型(39例)。按照麻醉方法分为单纯全身麻醉组(全麻组,83例)和全身麻醉复合骶管阻滞麻醉组(骶管麻醉组,42例)。手术方法均为TIP。随诊术后6个月出现的尿道瘘和尿道狭窄患儿。采用多因素分析影响手术效果的相关因素。结果尿道下裂手术后出现尿道瘘11例,其中全麻组8例(9.64%),骶管麻醉组3例(7.14%),2组比较差异无统计学意义(χ^(2)=0.223,P=0.636);尿道狭窄12例,其中全麻组8例(9.64%),骶管麻醉组4例(9.52%),2组比较差异无统计学意义(χ^(2)=0.001,P=0.984)。Logistic回归多因素分析显示,近端尿道下裂类型(OR=0.036,95%CI:0.003~0.511,P=0.014)、阴茎头宽度(OR=0.469,95%CI:0.220~0.998,P=0.049)是TIP术后尿道瘘发生的独立危险因素;近端尿道下裂类型(OR=0.004,95%CI:0.000~0.146,P=0.002)、尿道板宽度(OR=0.004,95%CI:0.000~0.422,P=0.020)、导尿管留置时间(OR=72.976,95%CI:1.802~2594.790,P=0.023)是术后尿道狭窄发生的独立危险因素。结论骶管麻醉方法与TIP尿道成形术后尿道瘘和尿道狭窄发生无明显关系。

Objective To assess the impact of caudal regional anesthesia on complications after hypospadias repair with tubularised incised plate urethroplasty(TIP).Methods A total of 125 cases with hypospadias undergoing TIP surgery from June 2017 to June 2019 at Beijing Children′s Hospital,Capital Medical University,were reviewed,aged 12-75 months,American Society of AnesthesiologistsⅠorⅡgrade.Totally,86 cases had distal and 39 cases suffered from proximal hypospadias.Caudal anesthetics were used in 42 cases(caudal anesthesia group)and general anesthetics were used in 83 cases(general anesthesia group).All cases were repaired by TIP procedure.The children with urethral fistula and urethral stricture were followed up for 6 months,and multivariate statistical analyses were performed.Results There were 11 cases of urethral fistula after hypospadias surgery,with 8 cases(9.64%)in the general anesthesia group and 3 cases(7.14%)in the caudal anesthesia group.There were no significant differences between the 2 groups(χ^(2)=0.223,P=0.636),and 12 cases of urethral stricture,with 8 cases(9.64%)in the general anesthesia group and 4 cases(9.52%)in the caudal anesthesia group.There were no significant differences between the 2 groups(χ^(2)=0.001,P=0.984).Based on multivariable Logistic regression,urethral fistula was associated with proximal hypospadias(OR=0.036,95%CI:0.003-0.511,P=0.014),and the width of glans(OR=0.469,95%CI:0.220-0.998,P=0.049).Urethral stricture was correlated with proximal hypospadias(OR=0.004,95%CI:0.000-0.146,P=0.002),the width of urethral plate(OR=0.004,95%CI:0.000-0.422,P=0.020),and the duration of catheter(OR=72.976,95%CI:1.802-2594.790,P=0.023).Conclusion Caudal regional anesthesia appears to have no impacts on urethral fistula and stricture after hypospadias repair.