3种不同组织额外覆盖物在小儿尿道下裂Snodgrass术临床应用研究

Clinical analysis of three kinds of additional tissue coverings in children with hypospadias treated by Snodgrass surgical method

目的:探究3种不同组织额外覆盖物在小儿尿道下裂Snodgrass术的临床应用情况。方法:回顾性分析2016年1月—2021年1月在我院行Snodgrass术的尿道下裂患儿180例,收集术前患儿临床资料,包括年龄、尿道缺损长度、阴茎头直径、尿道覆盖物等情况。根据尿道覆盖物的不同,将患儿分为常规覆盖物组、睾丸鞘膜覆盖物组、尿道板旁筋膜覆盖物组、阴囊纵隔筋膜瓣覆盖物组进行临床分析。术后1、3、6、12个月随访患儿,统计分析不同尿道覆盖物患儿术后恢复及并发症情况。结果:180例患儿均顺利完成手术,各组间年龄、尿道缺损长度、阴茎头直径、尿道板宽度比较差异均无统计学意义。术后并发症统计分析显示,常规覆盖物组术后出现尿道瘘9例,额外覆盖物组出现尿道瘘11例,差异有统计学意义(P=0.019);常规覆盖物组总并发症14例,额外覆盖物组总并发症21例,差异有统计学意义(P=0.013)。3组不同额外覆盖物术后并发症比较,睾丸鞘膜覆盖物组术后尿道瘘和总并发症的发生率低于其他2组,差异有统计学意义(P=0.009、P=0.020)。结论:额外尿道覆盖物在小儿尿道下裂Snodgrass术具有重要作用,可以有效减少尿道瘘并发症出现。

Objective:To explore the clinical application of three kinds of additional tissue coverings in children with hypospadias treated by Snodgrass surgical method.Methods:We collected the preoperative clinical data of children with hypospadias treated by Snodgrass surgical method from January 2016 to January 2021 in our hospital including average age,urethral defect length,the penis head diameter and so on.According to the different urethral coverings,the children were divided into conventional group,testicular sheath group,parabathal fascia group and mediastinal fascia flap of scrotum group.We conducted the follow-up in the postoperative 1,3,6 and 12 months and statistically analyzed the incidence of postoperative complications among groups.Results:All the 180 children underwent surgery successfully.There were no statistically significant differences in age,urethral defect length,penile head diameter or urethral plate among all groups.There were 9 cases of urethral fistula in the no extra covering group,and 11 cases of urethral fistula in the extra covering group.The difference between them was statistically significant(P=0.019).The incidence of total complications in the no additional coverage group was14 cases and 21 cases in the additional coverage group(P=0.013).The incidence of postoperative urethral fistula and total complications in the testis sheath group were lower than those in the other two groups,and the differences among groups were statistically significant(P=0.009,P=0.020).Conclusion:Additional urethral covering plays an important role in Snodgrass surgery for children with hypospadias,which can effectively reduce the incidence of urethral fistula.