横行游离岛状包皮内板Onaly尿道成形术治疗小儿近端型尿道下裂及术后阴茎头裂开的影响因素分析

Clinical study of onaly urethroplasty with transverse free island prepuce inner plate in the treatment of proximal hypospadias in children and analysis of the factors of postoperative penile head dehiscence

目的探讨横行游离岛状包皮内板Onaly尿道成形术治疗小儿近端型尿道下裂的临床疗效及术后阴茎头裂开的影响因素。方法选择2016年1月至2021年1月在本院行手术治疗的88例近端型尿道下裂患儿作为研究对象,其中73例行传统Onlay术(传统Onlay组),15例行游离Onlay术(游离Onlay组),根据术后阴茎头是否裂开将患儿分为阴茎头裂开组(16例)和阴茎头未裂开组(72例)。比较两组患儿的术后并发症发生率,并统计两组术后的尿量和最大尿流率。采用logistic回归分析对影响术后阴茎头裂开的因素进行分析。结果传统Onlay组的术后并发症发生率高于游离Onlay组,但差异无统计学意义[24.66%(18/73)vs.20.00%(3/15),χ2=0.149,P>0.05];传统Onlay组的术后尿量和最大尿流率均低于游离Onlay组(均P<0.05);单因素分析结果显示,阴茎头裂开组的阴茎头直径、术中冠口距、尿管型号均短于阴茎头未裂开组(均P<0.001);logistic回归分析结果显示,阴茎头直径、术中冠口距、尿管型号均为影响术后阴茎头裂开的独立影响因素(均P<0.05)。结论游离Onlay术不会增加术后并发症的发生率,且可增加术后尿量和最大尿流率,阴茎头直径、术中冠口距、尿管型号均会对术后阴茎头裂开产生不同程度的影响。

Objective To investigate the clinical study of proximal hypourethral fissure and the factors of penile fissure.Methods A total of 88 children with proximal hypospadias who underwent surgical treatment in our hospital from January 2016 to January 2021 were selected as the research objects,including 73 cases of traditional Onlay surgery(traditional Onlay group)and 15 cases of free Onlay surgery(free Onlay group).According to whether the glans dehiscence occurred after surgery,the children were divided into glans dehiscence group(16 cases)and glans non-dehiscence group(72 cases).The incidence of postoperative complications was compared between the two groups,and the postoperative urine volume and maximum urinary flow rate were recorded.logistic regression analysis was used to analyze the factors affecting postoperative glans dehiscence.Results The incidence of postoperative complications in traditional Onlay group was higher than that in free Onlay group,but the difference was not statistically significant[24.66%(18/73)vs.20.00%(3/15),χ2=0.149,P>0.05].The postoperative urine volume and maximum urine flow rate in the traditional Onlay group were lower than those in the free Onlay group(all P<0.05).The results of the univariate analysis showed that,there were statistical differences in the penis head diameter,intraoperative crown and mouth distance,and ureter type of the children with split and unsplit penis head(all P<0.05).The results of the logistic regression analysis showed that,penile head diameter,intraoperative crown and mouth distance,and catheter model were all independent factors affecting postoperative penis head opening.Conclusions Free Onlay will not increase the incidence of postoperative complications,and can increase postoperative urine volume and maximum urine flow rate.Penile head diameter,intraoperative crown and mouth distance,and catheter model will have different effects on postoperative penile head opening.