九院尿道下裂治疗10年回顾性的研究.pdf

根据手术分期分为初次手术组和再次手术组；根据膀胱造瘘情况分为 膀胱造瘘组和非膀胱造瘘组，对术后并发症发生情况应用SPSS统计学 软件进行统计学分析。 结果 尿道板纵切卷管、膀胱黏膜和带蒂包皮内板尿三种术式术后尿瘘 的发生率分别为21.3 ％、7.1 ％和24.4 ％。三种术式近期尿瘘发生率较 前期均有显著降低。青春期前后、手术不同分期以及是否膀胱造瘘等 在三种术式术后尿瘘发生率方面均无统计学差异（P0.05 ）。后段型 尿道下裂在膀胱粘膜尿道成形术中尿瘘发生率较前段型和中段型有显 著降低（P0.05 ）而在另外两种术式中未得到类似的结果（P0.05 ）。 结论 我院尿道下裂数据库的初步开发与建立有较大的意义。近期我院 尿道下裂的临床治疗水平有显著提高，接近国际先进水平。 尿道板纵切卷管尿道成形术是一种适用于无阴茎下弯或伴有轻 度阴茎下弯的各型尿道下裂和再手术者的优良术式。带蒂包皮内板尿 道成形术术后尿瘘的发生率与前者相仿，同样有着较好的术后效果。 膀胱粘膜尿道成形术适用于各种类型的尿道下裂，尤其是后段型尿道 下裂，术后尿瘘的发生率较前两者有明显降低，且差异有统计学意义。 青春期前后、初次手术与再次手术、是否行膀胱造瘘术，术后尿 瘘发生率差异并无统计学意义。术者可以根据术者自己的经验和习 惯、患者的具体病情以及术中的具体情况等分析考虑手术的方式、分 期及是否采用膀胱造瘘使尿流改道等。 术中仔细操作、良好止血、合理缝合、新建尿道采用血供良好的 皮瓣覆盖均能够有效的降低术后尿瘘的发生。 关键词：尿道下裂，数据库，并发症，SPSS RETROSPECTIVE REPORT OF 10 YEARS EXPERIENCES IN TREATING HYPOSPADIAS OF NINTH PEOPLES’ HOSPITAL ABSTRACT Objective Collect the medical records of hypospadiac patients who underwent surgeries in Department of Urology and Orthopedics in Ninth Peoples’ Hospital from February 1997 to December 2006 so as to set up the database of hypospadias and analysis the current situation of hypospadias repair in our hospital. 242 cases of hypospadias chosen from the database were reviewed retrospectively. By Chi-square test, factors which affected the incidence of fistula after surgery were analyzed statistically. Material and Method A total of 242 patients who underwent urethroplasty in our hospital from February 1997 to December 2006 with a mean (SD) age of 18 (9) years (range from 1~45 years) were considered. We used different techniques such as tubularised incised plate (TIP), bladder mucosa graft (BMG) and onlay island flap (OIF) urethroplasty depending on the patients’ anatomy, the location of the hypospadiac meatus and the chordee. According to the operation date and stage, the patients’ age and types of hypospadia