Snodgrass术治疗尿道下裂术前术后尿流率联合残余尿检测的意义
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摘要
目的探索行Snodgrass术治疗冠状沟型尿道下裂手术前后尿流率联合残余尿检查的临床意义。方法分析2012年1月至2016年12月间98例行Snodgrass术的冠状沟型尿道下裂患儿手术前后尿流率及残余尿量,比较术前和术后差异。尿流率测定仪纪录尿流曲线、最大尿流率、平均尿流率、排尿量、排尿时间、最大尿流时间;超声测量膀胱残余尿量并检查膀胱及上尿路形态。结果所有冠状沟型尿道下裂患儿超声检查均未发现膀胱和上尿路形态学异常。所有冠状沟型尿道下裂不同年龄段患儿术前、术后Qmax较正常儿童低。其中狭窄组26例、无狭窄组72例,狭窄组患儿术后3个月最大尿流率、平均尿流率、排尿时间、最大尿流时间、排尿量和残余尿量分别为(7.18±1.96)mL/s、(5.28±2.07)mL/s、(31.72±29.57)s、(15.88±11.94)s、(139.03±77.50)mL、(19.26±18.84)mL;而无尿道狭窄组相应各值分别为(8.09±3.39)mL/s、(6.45±2.02)mL/s、(29.05±11.59)s、(9.31±6.76)s、(133.87±64.11)mL、(16.42±14.31)mL。狭窄组最大尿流率、平均尿流率小于无狭窄组,而排尿时间最大尿流时间长于无狭窄组,其差异均有统计学意义(P <0.05)。狭窄组术后3个月钟形曲线占11.5%,平台曲线占65.4%;而无狭窄组分别为26.3%、45.8%,其差异也有统计学意义(P <0.05)。同时发现患儿术后6个月复查时结果与3个月时类似,而术后2周的狭窄组与非狭窄组结果之间并无明显差异。但值得注意的是术后2周、3、6个月所有患儿各项指标呈逐渐恢复趋势。结论 Snodgrass术治疗尿道下裂术后尿流率联合残余尿检查有利于发现术后尿道狭窄,尤其手术后3个月内复查更有意义。
Objective To explore the changes of preoperative and postoperative urinary flow rate,postvoid residual urine and other indicators in patients with coronal hypospadias treated with Snodgrass and their clinical significance.MethodsThe preoperative and postoperative urinary flow rate of 98 patients with coronal hypospadias treated with Snodgrass from January 2012 to December 2016 were analyzed and compared.All patients underwent ultrasonography to examine the morphology of bladders and upper urinary tracts,uroflow ratio examination to calculate uroflow curve,maximum flow rate,average flow rate,voided volume,voiding time,maximum flow time,and bladder capacity test to determine the postvoid residual urine.Results There were no significant difference of the ultrasonic morphology of the bladders and upper urimry tracts in all children with coronal hypospadias.All patients with coronal hypospadias at different ages had lower Qmax before and after surgery than normal children.Among them,there were 26 cases in the stenosis group and 72 cases in the non-stenosis group.Of the patients with stenosis at 3 months after surgery,the maximum flow rate(Qmax)was(7.18±1.96)m L/s,the average flow rate(Qave)was(5.28±2.07)mL/s,voiding time was(31.72±29.57)s,maximum flow time was(15.88±11.94)s,the voided volume was(139.03±77.50)m L,and postvoid residual urine was(19.26±18.84)m L.Of the non-stenosis group,the Qmax was(8.09±3.39)mL/s,the Qave was(6.45±2.02)mL/s,voiding time was(29.05±11.59)s,maximum flow time was(9.31±6.76)s,the voided volume was(133.87±64.11)mL,and postvoid residual urine was(16.42±14.31)mL.It can be seen that the maximum flow rate and average flow rate of the stenosis group are smaller than that of the non-stenosis group,and the maximum urine flow time of the stenosis group is longer than that of the non-stenosis group.Of the patients with stenosis at 3 months after surgery,11.5%patients had bell-shaoed uroflow curve,and 65.4%had platform uroflow curve;while 26.3%of the non-stenosis group had bell-shaoed uroflow curve,and 45.8%had platform uroflow curve.The difference of the uroflow curve between the2 groups was significant(P<0.05).At the same time,it was found that the results of the 6-month postoperative review were similar to those of the 3-month postoperative review,and there was no significant difference between the results of 2-week postoperative stenosis groups and those of the non-stenosis groups.However,it should be noted that all the indicators of all the patients showed a gradual recovery trend 2 weeks,3 months and 6 months after surgery.ConclusionUrinary flow rate combined with postvoid residual urine after Snodgrass therapy for coronal hypospadias can be used to detect postoperative urethral stricture.In particular,3 months after surgery to review more meaningful.
Objective To explore the changes of preoperative and postoperative urinary flow rate,postvoid residual urine and other indicators in patients with coronal hypospadias treated with Snodgrass and their clinical significance.MethodsThe preoperative and postoperative urinary flow rate of 98 patients with coronal hypospadias treated with Snodgrass from January 2012 to December 2016 were analyzed and compared.All patients underwent ultrasonography to examine the morphology of bladders and upper urinary tracts,uroflow ratio examination to calculate uroflow curve,maximum flow rate,average flow rate,voided volume,voiding time,maximum flow time,and bladder capacity test to determine the postvoid residual urine.Results There were no significant difference of the ultrasonic morphology of the bladders and upper urimry tracts in all children with coronal hypospadias.All patients with coronal hypospadias at different ages had lower Qmax before and after surgery than normal children.Among them,there were 26 cases in the stenosis group and 72 cases in the non-stenosis group.Of the patients with stenosis at 3 months after surgery,the maximum flow rate(Qmax)was(7.18±1.96)m L/s,the average flow rate(Qave)was(5.28±2.07)mL/s,voiding time was(31.72±29.57)s,maximum flow time was(15.88±11.94)s,the voided volume was(139.03±77.50)m L,and postvoid residual urine was(19.26±18.84)m L.Of the non-stenosis group,the Qmax was(8.09±3.39)mL/s,the Qave was(6.45±2.02)mL/s,voiding time was(29.05±11.59)s,maximum flow time was(9.31±6.76)s,the voided volume was(133.87±64.11)mL,and postvoid residual urine was(16.42±14.31)mL.It can be seen that the maximum flow rate and average flow rate of the stenosis group are smaller than that of the non-stenosis group,and the maximum urine flow time of the stenosis group is longer than that of the non-stenosis group.Of the patients with stenosis at 3 months after surgery,11.5%patients had bell-shaoed uroflow curve,and 65.4%had platform uroflow curve;while 26.3%of the non-stenosis group had bell-shaoed uroflow curve,and 45.8%had platform uroflow curve.The difference of the uroflow curve between the2 groups was significant(P<0.05).At the same time,it was found that the results of the 6-month postoperative review were similar to those of the 3-month postoperative review,and there was no significant difference between the results of 2-week postoperative stenosis groups and those of the non-stenosis groups.However,it should be noted that all the indicators of all the patients showed a gradual recovery trend 2 weeks,3 months and 6 months after surgery.ConclusionUrinary flow rate combined with postvoid residual urine after Snodgrass therapy for coronal hypospadias can be used to detect postoperative urethral stricture.In particular,3 months after surgery to review more meaningful.
引文
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[2]张干林,张金明.尿道下裂病因学研究进展[J].中华小儿外科杂志,2014,35(3):230-232.
[3]THORUP J,MCLACHLAN R,CORTES D,et al.What is new in cryptorchidism and hypospadias-a critical review on the testicular dysgenesis hypothesis[J].J Pediatr Surg,2010,45(10):2074-2086.
[4]NORDENVALL A S,FRISEN L,NORDENSTROM A,et al.Population based nationwide study of hypospadias in Sweden,1973 to 2009:Incidence and risk factors[J].J Urol,2014,191(3):783-789.
[5]文建国,童尔昌.小儿尿流测定及其临床意义[J].中华小儿外科杂志,1990,11(1):29.
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[7]蒋先镇,龙永其,万光霞,等.1024例儿童尿流率调查[J].中华泌尿外科杂志,2005,26(10):706-708.
[8]SNODGRASS W.Tubularized,incised plate urethroplasty for distal hypospadias[J].J Urol,1994,151(2):464-465.
[9]SNODGRASS W,KOYLE M,MANZONI G.Tubularized incised plate hypospadias repair for proximal hypospadias[J].Urol,1998,159(6):2129-2131.
[10]李晓东,许宁,薛学义,等.一期无管化尿道板纵行切开卷管尿道成形术治疗尿道下裂术后疼痛和并发症的观察[J].中国修复重建外科杂志,2014,28(12):1505-1508.
[11]万光霞,马劲松.尿道板纵切卷管尿道成形术(Snodgrass)在小儿尿道下裂的临床治疗方面的疗效分析[J].吉林医学,2017,38(4):622-624.
[12]HOLLAND A J,SMITH G H,CASS D T.Clinical review of the‘Snodgrass’hypospadias repair[J].Aust N Z J Surg,2000,70(8):597-600.
[13]RUDIN IUé,MARUKHNENKO D V,GARMANOVA T N,et al.Balanoplasty in accordance with the normal anatomy--the key to successful correction of hypospadias[J].Urologiia,2013,(3):74-78.
[14]SCARPA M G,CASTAGNETTI M,BERRETTINI A,et al.Urinary function after Snodgrass repair of distal hypospadias:comparison with the Mathieu repair[J].Pediatr Surg Int,2010,26(5):519-522.
[15]PIPLANI R,AGGARWAL S K,RATAN S K.Role of uroflowmetry before and after hypospadias repair[J].Urol Ann,2018,10(1):52-58.
[16]蒋先镇,万光霞,阳建福.尿流率测定在尿道下裂矫治术后排尿功能评估中的意义[J].中华泌尿外科杂志,2008,29(2):133-134.
[17]徐万华,尹鉴淳,李守林,等.尿道下裂术前尿道功能的尿动力学评估[J].中华小儿外科杂志,2010,31(4):255-257.
[18]文建国,冯全得.尿道下裂术后尿流率联合残余尿测定的意义[J].临床小儿外科杂志,2015,14(6):462-465.
[2]张干林,张金明.尿道下裂病因学研究进展[J].中华小儿外科杂志,2014,35(3):230-232.
[3]THORUP J,MCLACHLAN R,CORTES D,et al.What is new in cryptorchidism and hypospadias-a critical review on the testicular dysgenesis hypothesis[J].J Pediatr Surg,2010,45(10):2074-2086.
[4]NORDENVALL A S,FRISEN L,NORDENSTROM A,et al.Population based nationwide study of hypospadias in Sweden,1973 to 2009:Incidence and risk factors[J].J Urol,2014,191(3):783-789.
[5]文建国,童尔昌.小儿尿流测定及其临床意义[J].中华小儿外科杂志,1990,11(1):29.
[6]YANG S S,CHIANG I N,HSIEH C H,et al.The Tzu Chi nomograms for maximum urinary flow rate(Qmax)in children:comparison with Miskolc nomogram[J].BJU Int,2014,113(3):492-497.
[7]蒋先镇,龙永其,万光霞,等.1024例儿童尿流率调查[J].中华泌尿外科杂志,2005,26(10):706-708.
[8]SNODGRASS W.Tubularized,incised plate urethroplasty for distal hypospadias[J].J Urol,1994,151(2):464-465.
[9]SNODGRASS W,KOYLE M,MANZONI G.Tubularized incised plate hypospadias repair for proximal hypospadias[J].Urol,1998,159(6):2129-2131.
[10]李晓东,许宁,薛学义,等.一期无管化尿道板纵行切开卷管尿道成形术治疗尿道下裂术后疼痛和并发症的观察[J].中国修复重建外科杂志,2014,28(12):1505-1508.
[11]万光霞,马劲松.尿道板纵切卷管尿道成形术(Snodgrass)在小儿尿道下裂的临床治疗方面的疗效分析[J].吉林医学,2017,38(4):622-624.
[12]HOLLAND A J,SMITH G H,CASS D T.Clinical review of the‘Snodgrass’hypospadias repair[J].Aust N Z J Surg,2000,70(8):597-600.
[13]RUDIN IUé,MARUKHNENKO D V,GARMANOVA T N,et al.Balanoplasty in accordance with the normal anatomy--the key to successful correction of hypospadias[J].Urologiia,2013,(3):74-78.
[14]SCARPA M G,CASTAGNETTI M,BERRETTINI A,et al.Urinary function after Snodgrass repair of distal hypospadias:comparison with the Mathieu repair[J].Pediatr Surg Int,2010,26(5):519-522.
[15]PIPLANI R,AGGARWAL S K,RATAN S K.Role of uroflowmetry before and after hypospadias repair[J].Urol Ann,2018,10(1):52-58.
[16]蒋先镇,万光霞,阳建福.尿流率测定在尿道下裂矫治术后排尿功能评估中的意义[J].中华泌尿外科杂志,2008,29(2):133-134.
[17]徐万华,尹鉴淳,李守林,等.尿道下裂术前尿道功能的尿动力学评估[J].中华小儿外科杂志,2010,31(4):255-257.
[18]文建国,冯全得.尿道下裂术后尿流率联合残余尿测定的意义[J].临床小儿外科杂志,2015,14(6):462-465.