分期与一期Duckett手术治疗尿道下裂的临床疗效对比

发布时间：2018-04-24 02:38

  本文选题：尿道下裂 + Duckett尿道成形术　； 参考：《广西医科大学》2015年硕士论文

【摘要】：目的：通过比较分期横裁包皮内板带蒂岛状皮瓣尿道成形术(Duckett)与一期Duckett手术治疗尿道下裂的临床疗效,总结分期与一期Duckett手术适应症及并发症的临床规律。方法：回顾性分析广西医科大学第一附属医院小儿外科在2012年10月至2014年12月治疗的尿道下裂患者162例,其中一期Duckett手术130例,年龄2岁-15岁,平均年龄(5.31±2.35)岁。分期Duckett手术32例,年龄2岁～13岁,平均年龄(4.59±2.58)岁。比较两组病例阴茎局部解剖条件,如阴茎头直径、尿道板发育情况、阴茎阴囊转位、阴茎弯曲程度、阴茎伸直后尿道外口位置、尿道缺损长度等指标。同时比较两组手术的临床效果,如尿瘘、尿道狭窄、尿道憩室、残存阴茎下曲、尿道崩裂等术后常见并发症的发生率和手术成功率。结果：一期Duckett手术130例中94例成功,手术成功率72.3%;分期Duckett手术32例中29例成功,手术成功率90.6%,分期Duckett手术组成功率明显高于一期Duckett手术,差异有统计学意义(X2=4.714,P=0.0300.05)。一期Duckett手术130例中36例出现术后并发症,并发症发生率27.7%,分期Duckett手术32例中3例出现术后并发症,并发症发生率9.4%,分期Duckett术后尿瘘、尿道狭窄及尿道憩室等主要并发症发生率低于一期Duckett手术,差异有统计学意义(P=0.0300.05)。一期Duckett手术组阴茎头直径≤1.2cm 43例,占33.1%(43/130例),分期Duckett手术组阴茎头直径≤1.2cm 25例(25/32例),占78.1%。分期Duckett手术组中阴茎头直径≤1.2CM的病例比一期Duckett手术组多(X2=21.396,P=0.0000.05),差异有统计学意义。一期Duckett手术组阴茎伸直后尿道外口位于阴茎阴囊交界处及阴囊29例,占22.3%(29/130例),分期Duckett手术组阴茎伸直后尿道外口位于阴茎阴囊交界处及阴囊25例,占78.1%(25/32例)。分期Duckett手术组阴茎伸直后尿道外口位于阴茎阴囊交界处及阴囊的比率比一期Duckett手术组高(X2=36.002,P=0.0000.05)。一期Duckett手术组尿道缺损长度(3.24±0.89cm),分期Duckett手术组尿道缺损长度(3.90±0.66cm),分期Duckett手术组尿道缺损长度大于一期Duckett手术组(t=2.930,P=0.0060.05),差异有统计学意义。一期Duckett手术组中阴茎弯曲程度呈中度96例,占73.8%(96/130例),呈重度34例,占26.2%(34/130例)。分期Duckett手术组阴茎弯曲程度呈中度5例,占15.6%(5/32例),呈重度27例,占84.4%(27/32例)。分期Duckett手术组中阴茎弯曲程度呈重度的病例比率比一期Duckett手术组高(X2=37.078,P=0.0000.05),差异有统计学意义。一期Duckett手术组尿道板发育差(≤0.4cm)106例,占81.5%(106/130例),分期Duckett手术组尿道板发育差(≤0.4cm)30例,占93.8%(30例/32例)。两组病例中尿道板发育情况的差异无统计学意义(X2=2.842,P=0.0920.05)。一期手术组合并阴茎阴囊转位22例,占16.9%(22/130例),分期手术组合并阴茎阴囊部分或完全转位6例,占18.8%(6/32例)。两组病例中阴茎阴囊转位的差异无统计学意义(X2=0.060,P=0.8070.05)。结论：尿道下裂的矫治策略必须在综合评估阴茎头大小、尿道板发育情况、阴茎阴囊转位、阴茎弯曲程度、阴茎伸直后尿道外口位置以及尿道缺损长度之后才能作出合理的决定。分期Duckett手术适应症如下：1.阴茎头窄小(直径≤1.2CM),阴茎发育不良,一期手术无法达到尿道正位开口者；2,尿道板纤维瘢痕挛缩导致阴茎重度下曲,需切断尿道板才能充分伸直,同时造成尿道长段缺损者；3.局部皮肤材料不足或发育欠佳,难以一期尿道成形及修复阴茎外观者；4.术者因技术水平不熟练或手术经验不足无法完成一期Duckett手术修复。正确选择手术方式将明显降低尿瘘或尿道狭窄等术后并发症的发生率,从而提高手术成功率。
[Abstract]:Objective : To compare the clinical effects of stage and primary Duckett ' s operation on hypospadia in 162 patients with hypospadia treated with Duckett ' s operation from October 2012 to December 2014 . The results showed that the operative success rate was 72.3 % in the first stage of Duckett ' s operation , and the operative success rate was 90.6 % . The incidence of complications and complications occurred in 36 of the 130 cases of Duckett ' s operation in the first stage . The incidence of complications was 27 . 7 % . The complication rate was 9 . 4 % . The diameter of the posterior urethra of Duckett ' s operation group was less than or equal to 1.2 cm ( 25 / 32 ) . The length of urethra defect ( 3.24 卤 0.89 cm ) and length of urethra defect ( 3.90 卤 0.66 cm ) in stage I Duckett operation group were higher than that of primary Duckett operation group ( t = 2.930 , P = 0.0060.05 ) . There were 22 cases , 16.9 % ( 22 / 130 cases ) in the first - stage operation combined with the penis scrotum , and 6 cases ( 18.8 % ) were divided into two groups ( X2 = 0.060 , P = 0.8070.05 ) . Conclusion : It is necessary to comprehensively evaluate the size of the penis , the development of urethral plate , transposition of penis scrotum , the degree of penile curvature , the position of the posterior urethra and the length of the urethra defect . The indications of the stage Duckett operation are as follows : 1 . The diameter of the penis is narrow ( diameter 鈮，

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