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,post void residual urine and other indicators in patients with coronal hypospadias treated with Snodgrass and their clini cal significance.Methods The preoperative and postoperative urinary flow rate of 98 patients with coronal hypo spadias treated with Snodgrass from January 2012 to December 2016 were analyzed and compared.All patients un derwent 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 differ ence 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 chil dren.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)mL/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)mL,and postvoid residual urine was(19.26±18.84)mL.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 the 2 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.Conclusion Urinary 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.
作者
王健健
李守林
陈进军
周蔚
王浩
文一博
王一鹤
文建国
WANG Jianjian;LI Shoulin;CHEN Jinjun;ZHOU Wei;WANG Hao;WEN Yibo;WANG Yihe;WEN Jianguo(Department of urology,Shenzhen Children′s Hospital,Shenzhen 518026,China)
出处
《实用医学杂志》
CAS
北大核心
2019年第2期217-220,共4页
The Journal of Practical Medicine
基金
国家自然科学基金(编号:81670689)
深圳市"医疗卫生三名工程"项目(编号:SZSM201612013)
关键词
儿童
尿道下裂
尿流率
残余尿
children
hypospadias
urinary flow rate
postvoid residual urine
