CAJ | 학술논문

目的评价延长尿道下裂术后留置导尿管在减少尿道狭窄中的作用.方法 2011年2月至2012年2月采用管形包皮岛状皮瓣法治疗尿道下裂104例,年龄2～3岁,平均2.4岁.矫正阴茎下弯后成形尿道长度为3 cm,包皮岛状皮瓣的宽度为1.2 cm.术后第2天采用双盲法将患儿平均分为两组,A组术后6周拔除导尿管,B组术后2周拔除导尿管,比较两组拔管后尿道狭窄的发生情况.分别在术前和拔除导尿管后2周、4周和3个月测量患儿最大尿流率.结果术后随访1～2年,平均1.5年.A组中术后出现尿瘘4例,B组6例.A组拔导尿管后2周和4周的最大尿流率分别为(11.3±3.4)ml/s和(10.8±2.5)ml/s,B组分别为(9.5±2.3)ml/s和(7.6±1.8)ml/s,两组比较差异均有统计学意义(P＜0.01).两组术前和拔导尿管后3个月最大尿流率比较差异均无统计学意义(P＞0.05).全部104例中有13例(12.5％)术后发生尿道狭窄.其中,A组术后有1例(1.9％)发生尿道狭窄;B组有12例(23.1％),两组比较,差异有统计学意义(P＜0.01).尿道狭窄发生时间为拔除导尿管后2～4周.A组术后出现尿道狭窄1例,再次留置导尿管4周后拔除导尿管未再发生尿道狭窄现象.B组术后出现尿道狭窄12例均行尿道扩张并留置导尿管,其中8例导尿管留置3～4周后拔除,未再出现尿道狭窄;4例于拔管后2～4周再次出现尿道狭窄,需再次留置导尿管3～4周.此4例拔除导尿管后,2例未再出现尿道狭窄现象,另2例在第3次拔除导尿管后4周和5周分别出现排尿困难现象,行狭窄段尿道劈开尿道造口术.结论术后6周拔除导尿管与术后2周拔除导尿管比较,可有效地减少尿道狭窄的发生.术后最大尿流率检查可以帮助发现尿道狭窄现象的发生.
목적 평개연장뇨도하렬술후류치도뇨관재감소뇨도협착중적작용.방법 2011년2월지2012년2월채용관형포피도상피판법치료뇨도하렬104례,년령2～3세,평균2.4세.교정음경하만후성형뇨도장도위3 cm,포피도상피판적관도위1.2 cm.술후제2천채용쌍맹법장환인평균분위량조,A조술후6주발제도뇨관,B조술후2주발제도뇨관,비교량조발관후뇨도협착적발생정황.분별재술전화발제도뇨관후2주、4주화3개월측량환인최대뇨류솔.결과 술후수방1～2년,평균1.5년.A조중술후출현뇨루4례,B조6례.A조발도뇨관후2주화4주적최대뇨류솔분별위(11.3±3.4)ml/s화(10.8±2.5)ml/s,B조분별위(9.5±2.3)ml/s화(7.6±1.8)ml/s,량조비교차이균유통계학의의(P＜0.01).량조술전화발도뇨관후3개월최대뇨류솔비교차이균무통계학의의(P＞0.05).전부104례중유13례(12.5％)술후발생뇨도협착.기중,A조술후유1례(1.9％)발생뇨도협착;B조유12례(23.1％),량조비교,차이유통계학의의(P＜0.01).뇨도협착발생시간위발제도뇨관후2～4주.A조술후출현뇨도협착1례,재차류치도뇨관4주후발제도뇨관미재발생뇨도협착현상.B조술후출현뇨도협착12례균행뇨도확장병류치도뇨관,기중8례도뇨관류치3～4주후발제,미재출현뇨도협착;4례우발관후2～4주재차출현뇨도협착,수재차류치도뇨관3～4주.차4례발제도뇨관후,2례미재출현뇨도협착현상,령2례재제3차발제도뇨관후4주화5주분별출현배뇨곤난현상,행협착단뇨도벽개뇨도조구술.결론 술후6주발제도뇨관여술후2주발제도뇨관비교,가유효지감소뇨도협착적발생.술후최대뇨류솔검사가이방조발현뇨도협착현상적발생.
Objective To evaluate the effects of prolonging indwelling catheter on reducing the occurrence of urethral strictures after hypospadias repair.Methods A total of 104 boys (mean age,2.4 years; age range,2-3 years) with hypospadia underwent hypospadias repair by tubularized preputial island flap technique.They were divided into two groups after operation.Catheter was removed by 6 weeks after repair in group A and by 2 weeks after repair in group B.The maximal urinary flow rate was measured before operation and in 2,4 weeks and 3 months after removing catheter.Urethral stricture was observed and treated after repair.Results During a mean follow up of 1.5 years,10 patients developed urethral fistula.No significant inter-group difference existed in maximal urinary flow rates of patients before the operation and at 3 months after removing catheter (P＞0.05).The maximal urinary flow rates were (11.3 ± 3.4) and (10.8 ± 2.5) ml/s in 2 weeks and 4 weeks after removing catheter in group A,but (9.5 ± 2.3) and (7.6 ± 1.8) ml/s in group B.The inter-group difference of maximal urinary flow rates was significant at 2 and 4 weeks after removing catheter (P＜0.01).The overall rate of urethral stricture was 12.5％.In group A (n =52),only 1 boy (1.9％) developed urethral stricture.And 12/52 patients (23.1％) had urethral strictures in group B.There was no significant inter-group difference in the rate of urethral fistula (P＞0.05) whereas the intergroup difference of urethral stricture rate was significant (P＜0.01).One boy of urethral stricture in group A was cured after urethral dilatation and catheterization.Eight patients were cured through once dilatation and catheterization and 4 needed twice dilatation in group B.Urethral stricture disappeared in 2,but urethrostomy was required in another 2.Conclusions Later catheter removal after hypospadias repair may significantly lower the occurrence of urethral stricture.And maximal urinary rate is useful in the diagnosis of urethral stricture.