间断缝合与连续缝合方法在Snodgrass术式治疗前段、中段型尿道下裂的应用及近期疗效比较

发布时间：2018-11-15 08:06

【摘要】：[目的]探讨间断缝合与连续缝合两种不同缝合方式在Snodgrass术治疗前段型、中段型尿道下裂中的应用及术后短期疗效的比较。[方法]选取自2015年5月至2016年5月间昆明医科大学第二附属医院泌尿外科无严重阴茎下曲的前段、中段型尿道下裂患者42例,年龄2～13岁,按照尿道下裂类型均分为2组:间断缝合组(21例),其中前段型(尿道开口位于阴茎头及冠状沟)13例、中段型(尿道开口位于阴茎体)8例;连续缝合组(21例),其中前段型12例、中段型9例。两组患者均实施Snodgrass手术,由我科具有专科资历、经验丰富的术者完成,两组患者均完成术后6个月、12个月随访。[结果]两组术前一般情况比较,差异无统计学意义(P0.05);间断缝合组手术时间长于连续缝合。但术后6个月复查尿瘘、尿道狭窄等并发症发生例数、术后二次手术实施例数,间断缝合组明显少于连续缝合组,差异有统计学意义(P0.05)。[结论]1.在治疗前段、中段型尿道下裂不伴有严重下曲畸形的病例时,Snodgrass术可考虑作为首选术式;2.相比较于连续缝合方式,采用间断缝合尿道板的方式会增加手术时间,但可明显减少术后尿瘘、尿道狭窄等并发症的发生,并有效避免二次手术的几率;3.两组患儿术前术后CBCL调查问卷中抑郁因子和多动因子改善明显,该术式可减轻患儿及家属心理负担,提高患儿生活质量。
[Abstract]:[objective] to explore the application of discontinuous suture and continuous suture in the treatment of anterior and middle type hypospadias by Snodgrass. [methods] from May 2015 to May 2016, 42 patients with middle urethral hypospadias, aged from 21 to 13 years, were selected from Urology Department, second affiliated Hospital of Kunming Medical University. According to the type of hypospadias, they were divided into two groups: the discontinuous suture group (21 cases), the anterior segment type (the urethral opening was located in the penis head and the coronal sulcus) in 13 cases, and the middle segment type (the urethral opening was located in the penis body in 8 cases). In the continuous suture group (21 cases), there were 12 cases of anterior segment type and 9 cases of middle segment type. Snodgrass was performed in both groups. The patients in both groups were followed up for 12 months and 6 months after operation. [results] there was no significant difference between the two groups before operation (P0.05), the operation time of discontinuous suture group was longer than that of continuous suture group. But six months after the re-examination of urinary fistula urethral stricture and other complications the number of cases of secondary operation after surgery interrupted suture group was significantly less than continuous suture group the difference was statistically significant (P0.05). [conclusion] 1. In the treatment of patients with anterior and middle hypospadias without severe hypospadias, Snodgrass procedure can be considered as the first choice. 2. Compared with continuous suture, intermittent suture of urethra plate can increase the operation time, but can obviously reduce the occurrence of postoperative complications such as urinary fistula and urethral stricture, and effectively avoid the probability of secondary operation. 3. The depression factor and hyperactivity factor in CBCL questionnaire were improved obviously in both groups, which can reduce the psychological burden and improve the quality of life of the children and their families.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.9

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