青春期前尿道下裂解剖数据测量:多中心病例系列研究

Anthropometric assessment on prepubertal boys with hypospadias: a multicenter case series

目的 研究青春期前尿道下裂各项相关人体测量学指标,数据化描述尿道下裂的解剖异常。方法 选择2021年3月—12月3个医学中心收治且符合选择标准的516例青春期前(TannerⅠ级)尿道下裂初次手术患儿作为研究对象,患儿年龄10~111个月,平均32.6个月。尿道下裂按照尿道缺损所达位置分型,远段型(尿道缺损在冠状沟或以远)47例(9.11%),中段型(尿道缺损在阴茎体段)208例(40.31%),近段型(尿道缺损在阴茎阴囊交界部或近侧)261例(50.58%)。测量以下指标:术前和术后即刻阴茎长度,重建尿道长度和尿道总长度;阴茎头区形态指标,包括术前阴茎头高度和宽度、AB、BC、AE、AD、有效AD、CC、BB、冠状沟尿道板宽度以及术后阴茎头高度和宽度、AB、BE和AD,其中A点为舟状沟顶点、B点为舟状沟侧方隆突、C点为阴茎头冠腹外侧隆突、D点为阴茎头冠背侧中点、E点为冠状沟腹侧中线;包皮帽形态指标,包括包皮帽宽度、内板和外板长度;阴囊形态指标,包括左侧、右侧和前方阴茎阴囊距;肛殖距,包括肛门阴囊距1(anoscrotal distance 1,ASD1)、ASD2、肛门阴茎距1(anogenital distance 1,AGD1)和AGD2。结果 远段型、中段型和近段型术前阴茎长度依次减少,重建尿道长度依次增加,术后尿道总长度依次减少(P<0.05)。术前远段型、中段型、近段型阴茎头高度依次递减(P<0.05),但阴茎头高度/宽度值大体接近;AB值、AD值、有效AD值依次减少(P<0.05);BB值、冠状沟尿道板宽度和(AB+BC)/AD值在各型间差异均无统计学意义(P>0.05)。术后阴茎头宽度各型间差异均无统计学意义(P>0.05);AB值和AB/BE值依次增加,AD值依次递减(P<0.05)。3型包皮内板长度递减(P<0.05),外板长度差异无统计学意义(P>0.05)。中段型、远段型和近段型左侧阴茎阴囊距依次增加(P<0.05)。ASD1、AGD1和AGD2从远段型至近段型依次递减(P<0.05)。其余指标仅在部分两两组间比较差异有统计学意义(P<0.05)。结论 尿道下裂的解剖异常可以用人体测量学指标进行数据化描述,以作为进一步规范化手术指导的基础。

Objective Anthropometric variants in prepubertal boys with hypospadias were assigned and assessed to illustrate anatomical malformation. Methods A total of 516 prepubertal(Tanner grade Ⅰ) boys with hypospadias who were admitted to three medical centers between March 2021 and December 2021 and met the selection criteria for primary surgery were selected. The age of the boys ranged from 10 to 111 months, with an average of 32.6 months.Hypospadias were classified according to the location of the urethral defect, 47 cases(9.11%) of the distal type(the urethral defect is in the coronal groove or beyond), 208 cases(40.31%) of the middle type(the urethral defect is in the penis body), and 261 cases(50.58%) of the proximal type(the urethral defect is at the junction or proximal side of the penis and scrotum). The following indexes were measured: penis length before and immediately after operation,reconstructed urethral length, and total urethral length. Morphological indicators of the glans area, including preoperative height and width of glans, AB, BC, AE, AD, effective AD, CC, BB, the urethral plate width of the coronal sulcus, and postoperative height and width of glans, AB, BE, and AD. In which point A is the distal endpoint of navicular groove,point B is the protuberance lateral to the navicular groove, point C is the ventrolateral protuberance of the glans corona,point D is the dorsal midline point of the glans corona, and point E is the ventral midline point of the coronal sulcus. The foreskin morphological indicators, including the foreskin width, inner foreskin length, and outer foreskin length. The scrotal morphological indicators, including the left, right, and front penile to scrotum distance. The anogenital distances,including anoscrotal distance 1(ASD1), ASD2, anogenital distance 1(AGD1), and AGD2. Results The penis length of the distal, middle, and proximal types decreased successively before operation, the reconstructed urethral length increased successively and the total urethral length decreased successively, these differences were all significant(P<0.05). The height and width of the glans of the distal, middle, and proximal types significantly decreased successively(P<0.05), but the height/width of the glans was generally close;AB value, AD value, and effective AD value significantly decreased successively(P<0.05);there was no significant difference in BB value, urethral plate width of the coronary sulcus, and(AB+BC)/AD value between the groups(P>0.05). There was no significant difference in the width of glans between the groups after operation(P>0.05);AB value and AB/BE value increased successively, and AD value decreased successively,these differences were all significant(P<0.05). The inner foreskin length in the 3 groups significantly decreased successively(P<0.05), while the outer foreskin length had no significant difference(P>0.05). The left penile to scrotum distance of middle, distal, and proximal types significantly increased successively(P<0.05). ASD1, AGD1, and AGD2 significantly decreased from distal type to proximal type successively(P<0.05). The other indicators’ differences were significant only between some groups(P<0.05). Conclusion The anatomic abnormalities of hypospadias can be described by anthropometric indicators, which can be used as the basis for further standardized surgical guidance.