Hui-Jing一期手术与Bracka分期手术治疗重度尿道下裂并发症的对比研究

A comparative study between one-stage Hui-Jing procedure and Bracka two-stage procedure for the treatment of severe hypospadias

目的比较Hui-Jing一期手术与Bracka分期手术治疗重度尿道下裂的并发症。方法回顾性分析2017年3月至2022年6月解放军总医院第七医学中心收治的75例重度尿道下裂患儿的临床资料,根据手术方式分为Hui-Jing组44例,中位年龄40.5(20.8,90.5)个月;尿道开口为阴茎阴囊型23例,会阴型21例。Bracka组31例,中位年龄38.0(24.0,44.5)个月;尿道开口为阴茎阴囊型15例,会阴型16例。两组的年龄(P=0.47)、尿道开口位置(P=0.74)差异无统计学意义。Hui-Jing组行Hui-Jing一期手术,即舌黏膜和纵行带蒂包皮瓣Onlay耦合尿道成形术+阴茎头纵切卷管成形术,术中横断尿道板后,采用舌黏膜铺板,纵裁包皮Onlay和Snodgrass阴茎头纵切卷管成形术。Bracka组采用一期口腔黏膜铺板和二期卷管成形术。Hui-Jing组和Bracka组术中矫正阴茎弯曲后的尿道板缺损长度分别为(4.30±0.84)cm和(4.56±0.79)cm,差异无统计学意义(P=0.18)。比较两组术后的尿道瘘、尿道狭窄、尿道憩室发生率。结果本研究75例手术均顺利完成,均未发生术中并发症。Hui-Jing组术后发生并发症15例(34.1%),其中尿道瘘12例(27.3%),尿道憩室3例(6.8%),无尿道狭窄病例。Bracka组术后发生并发症17例(54.8%),其中尿道狭窄9例(29.0%),尿道瘘6例(19.4%),尿道憩室2例(6.5%)。两组总并发症发生率比较差异无统计学意义(P=0.12),尿道瘘(P=0.61)和尿道憩室(P=0.13)发生率差异无统计学意义。Bracka组手术次数为(2.68±1.03)次,住院费用(12984.63±3808.15)元;Hui-Jing组手术次数为(1.36±0.53)次,住院费用(8490.54±3136.84)元,两组差异均有统计学意义(P<0.01)。结论Hui-Jing一期手术可用于治疗重度尿道下裂患儿,术后总并发症发生率、尿道瘘和尿道憩室发生率均与Bracka分期手术相当。

Objective To evaluate the mid-term complication rates of the Hui-Jing one-stage procedure(lingual mucosa combined with longitudinal preputial island flap onlay urethroplasty+tubularized incised plate glansplasty)versus the classic Bracka staged surgery for children with severe hypospadias.Methods A retrospective analysis was conducted on clinical data of 75 children with proximal hypospadias who were treated at the Seventh Medical Center of PLA General Hospital from March 2017 to June 2022.Of these patients,31 cases(15 cases penoscrotal type and 16 cases perineal type)were underwent the Bracka two-stage surgery with a median age of 38 months(24.0,44.5)and 44 cases underwent the Hui-Jing onestage procedure(23 cases penoscrotal type and 21 perineal type)with a median age of 40.5 months(20.75,90.5).The length of urethral plate defect after correction of penile curvature was(4.30±0.84)cm in the Bracka group and(4.56±0.79)cm in the Hui-Jing group,which also showed no significant difference.There was no statistically significant difference of the median age and the position of preoperative urethral opening between the two groups(P=0.47,P=0.74).The first stage of Bracka repair consists of orthoplasty and urethral bed substitution with free preputial graft.After 6 months,the urethral plate created from free graft was tabularized to form neourethra;Hui-Jing procedure group used the free lingual mucosal as urethral plate substitution,then we conducted longitudinal preputial island flap Onlay and Snodgrass phalloplasty.The incidence of postoperative urethral fistula,urethral stricture and urethral diverticulum was compared between the two groups of cases and the difference in efficacy between the two procedures was assessed.Results Among the 75 patients included in the study,there was no statistically significant difference in age or location of urethral meatus between the Bracka and Hui-Jing groups.In Bracka group,9 cases of urethral stricture(29.0%),6 case of urethral fistula(19.4%),and 2 cases of urethral diverticulum(6.5%)occurred after surgery,while 12 cases of urethral fistula(27.3%)and 3 case of urethral fistula(6.8%)occurred in the Hui-Jing group.No urethral stricture occurred in Hui-Jing group.There was no statistically significant difference in overall incidence of complications between the two groups[17/31(54.8%)vs.15/44(34.1%),P=0.12].The incidence of urethral fistula and urethral diverticulum show no significant differences between two groups(19.4%vs 27.3,P=0.61,6.5%vs.6.8%,P=0.13).The number of operation in Bracka group was(2.68±1.03)and the hospitalization cost was(12984.63±3808.15)Yuan,while the number of operation in Hui-Jing group was(1.36±0.53)and the hospitalization cost was(8490.54±3136.84)Yuan.Conclusions The Hui-Jing one-stage procedure can be used for the surgical treatment of children with severe hypospadias.There is no urethral stricture happened in Hui-Jing group,while the general complication incidence and incidence of urethral fistula and diverticulum show no differences.