Zhao Shimeng, Qi Can, Jia Pengyu, Hu Yan, Gao Ruifeng, Chai Hongchao, Xin Chaojun, Zhou Yun
Urology, Hebei Children's Hospital, Shijiazhuang, CHN.
Nursing, Hebei Children's Hospital, Shijiazhuang, CHN.
Cureus. 2024 Oct 22;16(10):e72116. doi: 10.7759/cureus.72116. eCollection 2024 Oct.
This study aims to investigate the effects of intravenous tranexamic acid (TXA) hemostasis during pediatric hypospadias surgery on postoperative complications.
A prospective randomized controlled study was conducted involving patients undergoing transverse preputial island flap urethroplasty (Duckett procedure) for hypospadias between January 2021 and February 2023, who were divided into the TXA group and the control group. Clinical parameters between the two groups were compared, and single-factor and logistic regression analyses were conducted to determine the impact of TXA application on postoperative complications in hypospadias surgery.
A total of 124 hypospadias patients were followed up, with 64 in the TXA group and 60 in the control group. In the TXA group, intraoperative blood loss, electrotome usage, pre- to postoperative change in hemoglobin (ΔHB), and change in hematocrit were significantly lower compared to the control group (p＜0.05). Single-factor analysis of postoperative complications showed significant correlations with urethral defect length, electrotome usage, intraoperative blood loss, ΔHB, and bleeding complications after removing the penile bandage (p＜0.05). Multivariate logistic regression analysis indicated that TXA application (p=0.049), electrotome usage (p=0.003), intraoperative blood loss (p＜0.001), and ΔHB (p=0.001) were independent predictors of postoperative complications.
Intraoperative blood loss and pre- to postoperative change in hemoglobin are independent predictors of complications in the Duckett procedure for hypospadias surgery. Moreover, TXA can reduce blood loss and lower the risk of postoperative complications in patients undergoing the Duckett procedure.
本研究旨在探讨小儿尿道下裂手术中静脉注射氨甲环酸（TXA）止血对术后并发症的影响。
进行一项前瞻性随机对照研究，纳入2021年1月至2023年2月期间接受横行包皮岛状皮瓣尿道成形术（Duckett手术）治疗尿道下裂的患者，将其分为TXA组和对照组。比较两组的临床参数，并进行单因素和逻辑回归分析，以确定TXA应用对尿道下裂手术术后并发症的影响。
共对124例尿道下裂患者进行随访，TXA组64例，对照组60例。与对照组相比，TXA组术中失血量、电刀使用量、术前至术后血红蛋白变化量（ΔHB）和血细胞比容变化量均显著降低（p＜0.05）。术后并发症的单因素分析显示，与尿道缺损长度、电刀使用量、术中失血量、ΔHB以及拆除阴茎绷带后的出血并发症显著相关（p＜0.05）。多因素逻辑回归分析表明，TXA应用（p = 0.049）、电刀使用量（p = 0.003）、术中失血量（p＜0.001）和ΔHB（p = 0.001）是术后并发症的独立预测因素。
术中失血量和术前至术后血红蛋白变化量是Duckett法尿道下裂手术并发症的独立预测因素。此外，TXA可减少接受Duckett手术患者的失血量并降低术后并发症风险。
