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目的通过与传统术后留置导尿管或支架方法比较,探讨一期无管化尿道板纵行切开卷管尿道成形术(tubularized incised plate urethroplasty,TIP)对术后疼痛及并发症发生的影响。方法回顾分析2010年3月-2013年6月214例接受TIP治疗的先天性中远段尿道下裂患儿临床资料,其中术后留置导尿管68例(A组),留置支架70例(B组),未留置导尿管及支架76例(C组)。3组患儿年龄、尿道下裂分型和伴发畸形比较,差异均无统计学意义(P>0.05)。术后第2天采用Wong-Banker面部表情量表(WBS)和东安大略儿童医院疼痛评分(CHEOPS)行术后疼痛自我评估和行为学评估,记录术后并发症发生情况,并进行统计学分析。结果术后所有患儿均获随访,随访时间6~25个月,中位时间11.8个月。术后第2天A、B、C组中位WBS评分分别为4.0(0-10)、3.5(0-10)、3.0(0-10)分,中位CHEOPS评分分别为6.0(1-13)、6.0(1-13)、4.0(1-11)分;C组WBS评分、CHEOPS评分均显著低于A、B组(P<0.05),A、B组间两指标比较差异无统计学意义(P>0.05)。A、B、C组术后分别有27例(39.7%)、29例(41.4%)、13例(17.1%)发生并发症,其中各有14、15、9例发生2种或以上的并发症。3组间总并发症发生率比较,差异有统计学意义(P<0.05)。其中C组膀胱过度活动症、膀胱痉挛、尿路感染和尿瘘发生率均明显低于A、B组(P<0.05);切口感染、急性尿潴留、尿外渗、尿道口狭窄和尿道狭窄发生率比较,差异均无统计学意义(P>0.05)。结论一期无管化TIP治疗先天性中远段尿道下裂有效,与传统术后留置导尿管或支架相比,能够减轻患儿术后疼痛以及并发症的发生。
OBJECTIVE: To compare the postoperative management of postoperative urethral or stent placement with tubularized incised plate urethroplasty (TIP) by one-stage urethral catheterization . Methods The clinical data of 214 children with congenital middle and distal hypospadias treated with TIP from March 2010 to June 2013 were retrospectively analyzed. Among them, 68 cases were treated with catheterization (group A), 70 cases were treated with indwelling stent (B Group), without indwelling catheter and stent in 76 cases (group C). There was no significant difference in age, type of hypospadias and concomitant deformity between the three groups (P> 0.05). On the second postoperative day, postoperative pain self-assessment and behavioral evaluation were performed by using Wong-Banker Facial Expression Scale (WBS) and CHEOPS in Dong-an Children’s Hospital. The postoperative complications were recorded and statistically analyzed . Results All patients were followed up for 6 ~ 25 months and the median time was 11.8 months. On the second day after operation, the median WBS scores of A, B and C groups were 4.0 (0-10), 3.5 (0-10) and 3.0 (0-10) respectively, while the median CHEOPS scores were 6.0 (1-13 ), 6.0 (1-13) and 4.0 (1-11) respectively. The scores of WBS and CHEOPS in group C were significantly lower than those in group A and B (P <0.05). There was no significant difference between the two groups Significance (P> 0.05). There were 27 cases (39.7%), 29 cases (41.4%) and 13 cases (17.1%) in group A, B and C respectively. Complications occurred in 14, 15, and 9 cases in each group disease. The complication rates among the three groups were statistically significant (P <0.05). Including group C overactive bladder, bladder spasm, urinary tract infection and urinary fistula incidence were significantly lower than the A, B group (P <0.05); incision infection, acute urinary retention, urinary leakage, urethral stenosis and urethral stricture There was no significant difference in rates between two groups (P> 0.05). Conclusions The first phase of TIP treatment of hypospadia congenital subtotal effective and traditional postoperative indwelling catheter or stent, can reduce postoperative pain and complications in children.