Feng Jun, Yang Zhe, Tang Yong, Chen Wen, Zhao Mu-Xin, Ma Ning, Wang Wei-Xin, Xu Li-Si, Li Yang-Qun
From the 2nd Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Plast Surg. 2017 Dec;79(6):e41-e44. doi: 10.1097/SAP.0000000000001128.
We review our experience in urethrocutaneous fistula (UCF) repair after hypospadias surgery to investigate the risk factors for unsuccessful outcome.
Two hundred eleven patients had undergone UCF repair in our department from January 2005 to December 2015. This study included 185 patients who were followed up for more than 6 months. The age of patients, size, site and number of UCFs, number of UCF repairs, urethral complications other than UCF, and postoperative infection were included as potential risk factors. Binary logistic regression analysis was used for multivariate analysis. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. Stratified analysis and assessment of additive interaction were performed to have a better understanding of the relation between the risk factors.
Urethrocutaneous fistula repairs failed in 38 patients (20.5%) at first attempt. In the univariate analysis, size of UCFs (P = 0.012), times of UCF repair (P = 0.008), and postoperative infection (P = 0.044) were statistically related with the outcome of surgery. In the multivariate analysis, only the size of UCFs (P = 0.030; adjusted OR, 2.42; 95% CI, 1.09-5.36) and times of repair (P = 0.008; adjusted OR, 3.09; 95% CI, 1.35-7.07) were identified as risk factors for unsuccessful outcome. We had consistent results in the stratified analysis. No additive or multiplicative interaction between the 2 risk factors was found.
Our study suggested that UCF repairs after hypospadias surgery were easier to fail if one of the UCFs was larger than 2 mm or it had been repaired repeatedly. But when both factors existed, the increase of the risk was not statistically significant. The age of patients, site and number of UCFs, complications other than UCF, and postoperative infection were not significantly related to the success rate of UCF repair.
回顾我们在尿道下裂手术后尿道皮肤瘘（UCF）修复方面的经验，以调查手术结果不佳的风险因素。
2005年1月至2015年12月期间，我们科室有211例患者接受了UCF修复手术。本研究纳入了185例随访时间超过6个月的患者。患者年龄、UCF的大小、部位和数量、UCF修复次数、除UCF外的尿道并发症以及术后感染被作为潜在风险因素。采用二元逻辑回归分析进行多因素分析。计算比值比（OR）和95%置信区间（CI）。进行分层分析和相加交互作用评估，以更好地理解风险因素之间的关系。
38例患者（20.5%）首次尝试UCF修复失败。在单因素分析中，UCF的大小（P = 0.012）、UCF修复次数（P = 0.008）和术后感染（P = 0.044）与手术结果具有统计学相关性。在多因素分析中，仅UCF的大小（P = 0.030；调整后的OR，2.42；95% CI，1.09 - 5.36）和修复次数（P = 0.008；调整后的OR，3.09；95% CI，1.35 - 7.07）被确定为手术结果不佳的风险因素。分层分析结果一致。未发现这两个风险因素之间存在相加或相乘交互作用。
我们的研究表明，如果UCF之一大于2mm或已多次修复，尿道下裂手术后的UCF修复更容易失败。但当两个因素同时存在时，风险增加在统计学上并不显著。患者年龄、UCF的部位和数量、除UCF外的并发症以及术后感染与UCF修复成功率无显著相关性。
