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Onlay 与 Duckett 尿道成形术短期并发症的比较及危险因素分析。

Comparison of short-term complications between Onlay and Duckett urethroplasty and the analysis of risk factors.

机构信息

Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, 200040, China.

Department of Bioinformatics and Biostatistics, Center for Biomedical informatics, Shanghai Jiaotong University, Shanghai Children's Hospital, Shanghai, China.

出版信息

Int Urol Nephrol. 2019 May;51(5):783-788. doi: 10.1007/s11255-019-02125-1. Epub 2019 Mar 20.

Abstract

AIMS

To compare the short-term complications between Onlay and Duckett urethroplasty and to analyze the various risk factors cause the complications.

METHODS

The children with hypospadias who underwent treatment with Onlay or Duckett urethroplasty from November 2014 to June 2016 were followed up. The difference in complications between the two groups was analyzed. Moreover, a single-factor ANOVA was performed to analyze the length and curvature of the penis and the length of the urethral defect.

RESULTS

40 patients were treated by Duckett, while 54 by Onlay. In comparison to the Onlay group, the Duckett group showed the initial penile length was shorter (P = 0.044), the initial urethral defect (P = 0.024) and after the correction of chordee was longer (P < 0.001), and the initial penile curvature (P < 0.001) and after degloving (P < 0.001) was greater. Furthermore, the incidence of urethra percutaneous fistula (P = 0.041) and urethral stenosis (P < 0.001) in Duckett group was significantly higher. The analysis of risk factors showed that the age at the time of surgery, the initial penile curvature, the initial urethral defect, and the urethral defect after the correction of chordee were not correlated with the complications. The degree of penile curvature after skin degloving and urethra stenosis was significantly correlated (P = 0.019).

CONCLUSION

The incidence of complications of urethra percutaneous fistula and urethral stenosis after 1 year of Duckett was higher than that by Onlay approach. The greater the curvature of the penis after skin degloving, the more likely the occurrence of urethral stenosis after surgery.

摘要

目的

比较 Onlay 与 Duckett 尿道成形术的短期并发症,并分析导致并发症的各种危险因素。

方法

随访 2014 年 11 月至 2016 年 6 月期间接受 Onlay 或 Duckett 尿道成形术治疗的尿道下裂患儿,分析两组并发症的差异。此外,采用单因素方差分析分析阴茎长度和曲率及尿道缺损长度。

结果

40 例患儿行 Duckett 术,54 例行 Onlay 术。与 Onlay 组相比,Duckett 组的初始阴茎长度更短(P=0.044),初始尿道缺损(P=0.024)及矫正后尿道缺损更长(P<0.001),初始阴茎曲率(P<0.001)及脱套后(P<0.001)更大。此外,Duckett 组的尿道皮肤瘘(P=0.041)和尿道狭窄(P<0.001)发生率明显更高。危险因素分析显示,手术时的年龄、初始阴茎曲率、初始尿道缺损及矫正后尿道缺损与并发症无相关性,脱套后阴茎曲率与尿道狭窄程度呈显著相关性(P=0.019)。

结论

与 Onlay 术相比,Duckett 术后 1 年尿道皮肤瘘和尿道狭窄的发生率较高。脱套后阴茎曲率越大,术后发生尿道狭窄的可能性越大。

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