Comparison of complications and influencing factors between primary and staged Duckett surgery for severe hypospadias
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摘要: 目的 探讨一期与分期Duckett手术治疗重度尿道下裂后并发症比较, 并分析其影响因素。方法 回顾性选取2017年1月—2020年10月诊治的238例重度尿道下裂患儿的临床资料进行研究，入选患者在符合手术适应证的前提下采用1∶1配对的方式分为A组(予以一期手术)与B组(予以分期手术)，各119例，评估2组手术总时间、术中总出血量，观察2组治愈和并发症情况，并分析并发症发生原因。结果 A组的手术总时间(114.02±18.65) min长于B组(86.22±11.32) min(P < 0.05)；A组的术中总出血量、治愈率与B组比较，差异无统计学意义(P>0.05)。A组的并发症总发生率与B组比较，差异无统计学意义(P>0.05)；A组的尿道瘘率(7.56%)低于B组尿道瘘率(18.49%)，而尿道憩室率(7.56%)高于B组尿道憩室率(0.84%)，差异有统计学意义(P < 0.05)；A组的尿道狭窄率与B组比较，差异无统计学意义(P>0.05)。单因素分析显示，重度尿道下裂患儿术后并发症的发生与年龄、尿道下裂类型、术前阴茎弯曲、手术方式、术前阴囊发育不良显著相关(P < 0.05)；重度尿道下裂患儿术后并发症的发生与BMI、术前睾丸发育不良无相关性(P>0.05)。经二元logistic回归分析显示，年龄≥2岁、尿道下裂类型为Ⅳ型、术前存在阴茎弯曲是重度尿道下裂患儿发生并发症的独立危险影响因素(P < 0.05)。结论 一期Duckett手术与分期Duckett手术治疗重度尿道下裂患儿的成功率比较，差异无统计学意义，其中一期手术以尿道憩室并发症多见，分期手术以尿道瘘并发症多见，且年龄、尿道下裂类型、术前阴茎弯曲程度、术前阴囊发育不良、阴茎头直径、内膜蒂组织覆盖层、尿道缺损长度是重度尿道下裂患儿发生并发症的影响因素。Abstract: Objective To explore the comparison of complications after one-stage and staged Duckett surgery for severe hypospadias and analyze the influencing factors.Methods The clinical data of 238 children with severe hypospadias were retrospectively selected for research. The selection time was from January 2017 to October 2020. On the premise of meeting the surgical indications, the selected patients were divided into two groups by 1: 1 matching method, Group A (with one-stage operation) and group B (with staged operation), 119 cases in each group. The total operation time and total intraoperative blood loss of the two groups were evaluated, the cure and complications of the two groups were observed, and the causes of complications were analyzed.Results The total operation time of group A (114.02±18.65) minutes was longer than that of group B (86.22±11.32) minutes (P < 0.05). There was no significant difference in the total intraoperative blood loss or cure rate between group A and group B (P > 0.05). There was no significant difference in the total incidence of complications between group A and group B (P > 0.05). The urethral fistula rate of group A (7.56%) was lower than that of group B (18.49%). The rate of urethral diverticulum of group A (7.56%) was higher, while the rate of urethral diverticulum in group B was 0.84% (P < 0.05). There was no significant difference in the rate of urethral stricture between group A and group B (P > 0.05). Univariate analysis showed that the incidence of postoperative complications in children with severe hypospadias was significantly correlated with age, type of hypospadias, preoperative penile curvature, surgical method, and preoperative scrotal dysplasia (P < 0.05). There was no correlation between the incidence of postoperative complications and BMI index, preoperative testicular dysplasia (P > 0.05). Binary logistic regression analysis showed that age ≥ 2 years old, type Ⅳ hypospadias, and preoperative penile curvature were independent risk factors for complications in children with severe hypospadias (P < 0.05).Conclusion There is no significant difference in the success rate between the first-stage Duckett operation and the staged Duckett operation. However, the complications of the urethral diverticulum are more common in the first-stage operation. In staging operations, complications of urethral fistula are more common. Age, type of hypospadias, preoperative penile curvature, preoperative scrotal dysplasia, glans penis size, pedunculated intima coverage, length of urethral defect are associated with the incidence of postoperative complications in children with severe hypospadias
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Key words:
- primary surgery /
- staged surgery /
- hypospadias /
- complications /
- influencing factors
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表 1 2组围术期指标比较
X±S 组别 例数 手术总时间/min 术中总出血量/mL A组 119 114.02±18.65 12.78±2.05 B组 119 86.22±11.32 13.01±2.02 t 21.287 0.558 P < 0.001 0.577 
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表 2 2组治愈率比较
例(%) 组别 例数 治愈 未愈 A组 119 95(79.83) 24(20.17) B组 119 93(78.15) 26(21.85) χ2 0.101 P 0.750
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表 3 2组并发症情况比较
例(%) 组别 例数 尿道瘘 尿道憩室 尿道狭窄 总发生情况 A组 119 9(7.56) 9(7.56) 6(5.04) 24(20.17) B组 119 22(18.49) 1(0.84) 3(2.52) 26(21.85) χ2 6.268 6.681 1.039 0.101 P 0.012 0.01 0.308 0.750
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表 4 重度尿道下裂患儿术后并发症的单因素分析
例(%) 指标 并发症(n=50) χ2 P 年龄/岁 63.682 ＜0.001 ≥2 32(64.00) ＜2 18(36.00) BMI 0.990 0.625 ＜18.5 19(38.00) 18.5~25 17(34.00) ＞25 14(28.00) 尿道下裂类型 83.310 ＜0.001 Ⅳ型 35(70.00) Ⅲ型 15(30.00) 术前阴茎弯曲程度 81.251 ＜0.001 4级 30(60.00) 3级 20(40.00) 术前睾丸发育不良 3.036 0.081 是 19(38.00) 无 31(62.00) 术前阴囊发育不良 3.862 0.049 是 24(48.00) 无 26(52.00) 阴茎头直径/cm 61.583 ＜0.001 ≤1.2 32(64.00) ＞1.2 18(36.00) 内膜蒂组织覆盖层 71.303 ＜0.001 单层覆盖 31(62.00) 双层覆盖 19(38.00) 尿道缺损长度/mm 56.268 ＜0.001 ＞3 29(58.00) ≤3 21(42.00)
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表 5 重度尿道下裂患儿术后并发症的二元logistic回归分析
因素 β SE Wald χ2 df P OR 95%CI 下限 上限 年龄(1) 2.649 0.375 49.969 1 ＜0.001 14.138 6.783 29.467 尿道下裂类型(1) 3.093 0.396 61.049 1 ＜0.001 22.037 10.144 47.872 术前阴茎弯曲程度(1) 3.184 0.424 56.345 1 ＜0.001 24.136 10.511 55.424 术前阴囊发育不良(1) 0.629 0.323 3.798 1 0.051 1.876 0.996 3.532 阴茎头直径(1) 2.811 0.555 25.693 1 ＜0.001 16.627 5.607 49.300 内膜蒂组织覆盖层(1) 3.393 0.590 33.107 1 ＜0.001 29.766 9.370 94.562 尿道缺损长度(1) 2.709 0.567 22.831 1 ＜0.001 15.020 4.943 45.637
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