尿道板纵切卷管尿道成形术和横形带蒂岛状包皮皮瓣尿道成形术对小儿中后位尿道下裂的治疗效果

Snodgrass approach and transverse pedicled island-shaped prepuce flap urethroplasty in the treatment of pediatric middle and posterior hypospadias

目的对尿道板纵切卷管尿道成形(Snodgrass)术和横形带蒂岛状包皮皮瓣尿道成形术(Duckett术)对小儿中后位尿道下裂的治疗效果进行分析。方法选取2017年6月至2020年6月间福建医科大学附属南平第一医院收治的中后位尿道下裂患儿115例作为本研究对象,将其按照治疗方法的不同分为两组,Ⅰ组53例采用Snodgrass术,Ⅱ组62例采用Duckett术,分别对两组患儿的手术时间、术中出血量、手术治疗总有效率、术后并发症发生率进行比较。结果Ⅰ组和Ⅱ组患儿的手术时间分别为(123.98±21.35)min、(165.78±24.21)min,术中出血量分别为(29.32±8.42)ml、(58.29±13.45)ml,组间比较差异有统计学意义(P<0.001)。Ⅰ组和Ⅱ组中后位尿道下裂患儿手术治疗后的临床总有效率分别为60.38%和64.52%,组间比较差异无统计学意义(P>0.05)。但具体到中位尿道下裂患儿比较,则Ⅰ组高于Ⅱ组,但差异无统计学意义(P>0.05);而后位尿道下裂的比较,则Ⅰ组低于Ⅱ组,差异有统计学意义(P<0.05)。Ⅰ组患儿术后的尿瘘发生率显著高于Ⅱ组,而尿道狭窄及尿道憩室的发生率则显著低于Ⅱ组,差异有统计学意义(P<0.05)。结论Snodgrass术和Duckett术均可有效治疗小儿中后位尿道下裂,且疗效显著,但其适应证有所区别,小儿中位尿道下裂应用Snodgrass术治疗更有效,而小儿后位尿道下裂更适用Duckett术,具体操作可根据患儿的病情选择最佳方式。

Objective To analyze the therapeutic effect of Snodgrass approach and transverse pedicled island-shaped prepuce flap urethroplasty in the treatment of pediatric middle and posterior hypospadias. Methods A total of 115 children patients with middle and posterior hypospadias who were admitted between June 2017 and June 2020 were selected as the study subjects in Nanping First Hospital of Fujian Medical University. They were divided into two groups according to different treatment methods. 53 cases in group Ⅰ were treated with Snodgrass, and 62 cases in group Ⅱwere given transverse pedicled island-shaped prepuce flap urethroplasty. The surgery time, intraoperative blood loss,total effective rate of surgical treatment, and postoperative complications were compared between the two groups of children patients. Results The surgery time in the children patients in group Ⅰ and group Ⅱ were(123.98±21.35) min and(165.78±24.21) min, respectively, and the intraoperative blood loss was(29.32±8.42) ml and(58.29±13.45) ml, respectively. There were statistically significant differences between group Ⅰ and group Ⅱ(P<0.001). The clinical effective rates of children patients with middle and posterior hypospadias in group Ⅰ and group Ⅱ were 60.38% and64.52%, respectively, and there was no statistical difference(P>0.05). However, in the comparison of patients with middle hypospadias, the clinical effective rate in group Ⅰ was higher than that in group Ⅱ, but the difference was not significant(P>0.05);in the comparison of patients with posterior hypospadias with middle hypospadias, the clinical effective rate in group Ⅰ was lower than that in group Ⅱ, but the difference was statistically significant(P<0.05). The incidence rate of postoperative urinary fistula in group Ⅰ was significantly higher than that in group Ⅱ. The incidence rate of urethral stricture and urethral diverticulum in group Ⅰ was significantly lower than that in group Ⅱ, and the difference was statistically significant(P<0.05). Conclusion Snodgrass approach and transverse pedicled island-shaped prepuce flap urethroplasty are effective methods for the treatment of children patients with middle and posterior hypospadias,but the indications are different. Snodgrass has more advantages in the treatment of pediatric middle hypospadias, and the transverse pedicled island-shaped prepuce flap urethroplasty is more suitable for pediatric posterior hypospadias.The optimal approaches can be decided according to the specific conditions of children patients.