改良式Koyanagi尿道阴茎成形术联合高压氧辅助治疗先天性重型尿道下裂的临床效果分析

摘要

目的:探索改良式Koyanagi尿道阴茎成形术联合高压氧辅助治疗先天性重型尿道下裂的临床治疗效果.方法:采集绵阳四○四医院和绵阳市中心医院小儿外科收治的42例先天性重型尿道下裂患儿作为观察对象,随机将其分为对照组和试验组,每组各21例,对比组采用Koyanagi尿道阴茎成形术治疗,试验组采用改良式Koyanagi尿道阴茎成形术(Koyanagi尿道阴茎成形术+睾丸鞘膜覆盖技术)并联合高压氧辅助治疗,对比两组患者术后其阴茎下曲矫正效果、尿道重建成功率、阴茎外观满意度、转移包皮皮瓣存活率及术后并发症发生率等情况.结果:经统计分析发现,试验组患儿阴茎下曲矫正成功率为85.71％,明显高于对照组(x2=5.459,P=0.019);两组尿道重建总成功率比较,试验组同样具有明显优势(x2=4.200,P=0.040);两组术后阴茎外观满意度比较,试验组总满意度为85.71％,明显高于对照组的57.14％(x2=4.200,P=0.040);此外,试验组患儿术后经高压氧治疗后转移包皮皮瓣存活率显著高于对照组(x2=6.035,P =0.014),且并发症的发生率显著低于对照组(x2=4.725,P=0.030).结论:改良式Koyanagi尿道阴茎成形术联合高压氧辅助治疗先天性重型尿道下裂有极好的临床治疗效果,同时降低了患者的并发症的发生率,患儿家属满意度较高,有较高的临床参考价值.%Objectives:To investigate the clinical effect of modified Koyanagi penile reconstruction combined with hyperbaric oxygen therapy for congenital severe hypospadias.Methods:42 children with congenital severe hypospadias were collected from our hospital and Mianyang Central Hospital.They were randomly divided into two groups,control group and experimental group.The control group was treated with Koyanagi (Koyanagi technique + testicular sheath technique) and experimental group received modified Koyanagi penile reconstruction technique combined with hyperbaric oxygen therapy.The curative effect of penile correction,the success rate of urethral reconstruction,the satisfaction of penis appearance and flap survival rate in the transfer of foreskin,the incidence of postoperative complications and so on were compared between the two groups.Results:The statistical analysis showed that the success rate of penile correction was 85.71％ in experimental group,which was significantly higher than that in control group (x2 =5.459,P =0.019).Total success rate of urethral reconstruction in experimental group was significantly better than that in control group (x2 =4.200,P =0.040).The satisfaction degree of the penis in experimental group was significantly higher than that in control group (57.7％ vs 85.71％,P =0.040)(x2 =6.035,P =0.014),and the incidence of complications in experimental group was significantly lower than that in control group (x2 =4.725,P =0.030).Conclusion:Modified Koyanagi penile reconstruction technique combined with hyperbaric oxygen therapy for congenital severe hypospadias has an excellent clinical therapeutic effect,while reduces the incidence of complications in patients with high family satisfaction,and has a higher clinical reference value.