CAJ | 학술논문

目的探讨远端尿道下裂合理有效的手术方式.方法采用尿道口旁单侧包皮瓣加盖尿道成形术(OUPF术)51例,尿道板纵切卷管成形术(TIPU术)56例.2组年龄分别为4.9(3～17)和5.1(2～19)岁.病理分型:OUPF组冠状沟型、阴茎体前型、阴茎体中间型分别为6、14、31例;TIPU组分别为5、17、34例(P>0.05).统计学比较2种患儿手术时间、并发症、再手术率、术后外观、术后尿流率等参数.结果 OUPF组与TIPU组手术时间分别为(103±29)min和(92±21)min,术后尿瘘发生率分别为7.8%(4/51)和14.2%(8/56),6个月后外观满意度分别为84.8%(39/46)和87.8%(36/41),2组比较差异均无统计学意义(P>0.05).87例平均随访15(6～47)个月,OUPF组46例,TIPU术组41例.2组并发症总发生率分别为15.7%(8/51)和32.1%(18/56),再手术率分别为7.8%(4/51)和26.8%(15/56),2组比较差异均有统计学意义(P<0.01).尿流率随访76例,OUPF组39例,TIPU组37例,"平台梗阻型"尿流曲线分别为33.3%(13/39)和67.6%(25/37),平均尿流率分别为9.4(3.2～17.1)和6.8(3.3～15)ml/s,最大尿流率分别为12.2(3.9～22.9)和8.3(3.7～18.1)ml/s,2组比较差异均有统计学意义(P<0.01).结论 OUPF术符合解剖学结构,优于TIPU术,是远端尿道下裂理想的手术方式.
목적 탐토원단뇨도하렬합리유효적수술방식.방법 채용뇨도구방단측포피판가개뇨도성형술(OUPF술)51례,뇨도판종절권관성형술(TIPU술)56례.2조년령분별위4.9(3～17)화5.1(2～19)세.병리분형:OUPF조관상구형、음경체전형、음경체중간형분별위6、14、31례;TIPU조분별위5、17、34례(P>0.05).통계학비교2충환인수술시간、병발증、재수술솔、술후외관、술후뇨류솔등삼수.결과 OUPF조여TIPU조수술시간분별위(103±29)min화(92±21)min,술후뇨루발생솔분별위7.8%(4/51)화14.2%(8/56),6개월후외관만의도분별위84.8%(39/46)화87.8%(36/41),2조비교차이균무통계학의의(P>0.05).87례평균수방15(6～47)개월,OUPF조46례,TIPU술조41례.2조병발증총발생솔분별위15.7%(8/51)화32.1%(18/56),재수술솔분별위7.8%(4/51)화26.8%(15/56),2조비교차이균유통계학의의(P<0.01).뇨류솔수방76례,OUPF조39례,TIPU조37례,"평태경조형"뇨류곡선분별위33.3%(13/39)화67.6%(25/37),평균뇨류솔분별위9.4(3.2～17.1)화6.8(3.3～15)ml/s,최대뇨류솔분별위12.2(3.9～22.9)화8.3(3.7～18.1)ml/s,2조비교차이균유통계학의의(P<0.01).결론 OUPF술부합해부학결구,우우TIPU술,시원단뇨도하렬이상적수술방식.
Objective To compare two operative approaches for treatment of distal hypospadias. Methods One hundred and seven patients were recruited into the study. Group1(n=51) underwent OUPF and group2(n= 56) underwent TIPU repair. The results were analyzed with Chi-square and two Sided test. Results Operative times for OUPF and TIPU repair were (103±29) min and (92±21)min respectively (P>0.05). Fistula occurred rates were 7.8% (4/51)and 14.2% (8/56) (P>0.05). Satisfied rates for the appearance of the penis post-operation were 84.8% (39/46)and 87.8%(36/41) respectively (P>0.05). 87 patients were followed up. With mean follow-ups of 15 months (range 6 to 47) , the overall complication rates were 15.7% (8/51) and 32.1 % (18/56)(P<0. 05) for OUPF and TIPU repair. Only 4 of 51 patients (7.8%) undergoing OUPF underwent re-operations, compared to 15 of 56 patients (26.8%) undergoing TIPU repair (P<0.001). A plateau uroflow curve (vs normal bell curve)was observed in 33.3% (13/39)and 67.6(25/37) ,respectively(P<0. 001). The average flow rate was 9. 4 ml per second (range 3. 2 to 17. 1) in patients undergoing OUPF repair, compared to 6. 8 ml per second (3. 3 to 15, P<0. 05) for those undergoing TIPU repair. Mean peak flow rates were12.2 ml per second (range 3.9 to 22.9) and 8. 3 mi per second (range 3.7 to 18. 1, P<0.01) for OUPF and TIPU procedures. Conclusion OUPF is superior to TIPU in the surgical treatment of distal hypospadias.