改良Duplay术和Duckett术在儿童中重度尿道下裂中的临床应用比较

Comparison of efficacy of modified staged tubularized incised plate urethroplasty(modified Duplay)and one-stage transverse preputial island flap urethroplasty(Duckett)in treatment of moderate and severe hypospadias

目的比较改良分期尿道板纵切卷管尿道成形术(改良Duplay术)和一期横形带蒂岛状包皮皮瓣尿道成形术(Duckett术)治疗儿童中重度尿道下裂的疗效。方法收集81例中重度尿道下裂患儿的临床资料,根据术式不同分为改良Duplay术式组45例和Duckett术式组36例。比较2组的手术时间、出血量、住院费用、术后并发症和患儿家属对手术的满意度及治愈率。结果与Duckett术式组比较,改良Duplay术式组的手术时间较短,尿道狭窄和尿道憩室的发生率较低(P均<0.05)。2组的出血量、住院费用、尿瘘和龟头裂开的发生率和治愈率比较差异均无统计学意义(P均>0.05)。Duckett术式组患儿家属对手术的满意度高于改良Duplay术式组患儿家属对一期手术的满意度(P<0.05),与改良Duplay术式组患儿家属对二期手术的满意度相近(P>0.05)。结论改良Duplay术治疗中重度尿道下裂手术时间短、尿道狭窄和尿道憩室的发生率低,其临床应用优于Duckett术。

Objective To compare the efficacy of modified staged urethral plate longitudinal coiled urethroplasty(modified Duplay)and one-stage transverse pedicled island prepuce urethroplasty(Duckett)in the treatment of moderate and severe hypospadias.Methods Clinical data of 81 children with moderate and severe hypospadias were collected.81 children were divided into the modified Duplay group(n=45)and Duckett group(n=36)according to the surgical options.Average operation time,blood loss,hospitalization cost,postoperative complications,the degree of family satisfaction and cure rate were statistically compared between two groups.Results In the modified Duplay group,the average operation time was significantly shorter,the incidence of urethral stricture and urethral diverticulum was significantly lower than those in the Duckett group(all P<0.05).The blood loss,hospitalization cost,incidences of urinary fistula and glans dehiscencewas,and cure rates did not significantly differ between two groups(all P>0.05).The degree of family satisfaction s in Duckett operation group was significantly higher than that in modified Duplay operation group with the stageⅠsurgery(P<0.05),which was similar to that in modified Duplay operation group with the stageⅡsurgery(P>0.05).Conclusion The modified Duplay operation is superior to the Duckett operation in terms of shorter operation time,and lower incidence of urethral stricture and diverticulum.