改良Byars分期尿道成形术与传统术式治疗重型尿道下裂的队列研究

doi:10.3877/cma.j.issn.1674-3253.2025.04.006

目的

比较改良Byars分期术式与传统术式治疗重型尿道下裂的临床疗效。

方法

回顾性分析2012至2023年中山大学附属第一医院收治的82例重型尿道下裂患儿临床资料。31例行传统Byars术式，为传统组；51例行改良Byars术式，为改良组。改良Byars术式在传统术式基础上，Ⅰ期加做阴茎头成形术，Ⅱ期采用Y形皮瓣联合阴茎头隧道进行尿道成形术。比较两组患儿的围手术期指标、术后并发症发生率及随访结果。

结果

两组术前基线资料、手术时间、出血量，术后尿瘘、尿道狭窄、尿道憩室、阴茎下曲等并发症发生率差异均无统计学意义。改良组冠状沟尿瘘、阴茎头裂开发生率（0%）均明显低于传统组（12.90%，P=0.008）。改良组尿道正位开口率为100%，显著高于传统组的83.88%（P=0.003）；改良组阴茎外观满意度HOPE评分为（8.75±0.15）分，显著高于传统组的（7.94±0.30）分（P=0.010）。改良组术后尿道开口位置正常，呈自然裂隙状，阴茎外观接近正常。

结论

与传统Byars分期术式相比，改良术式能够显著降低冠状沟尿瘘和阴茎头裂开风险，提高尿道正位开口率和阴茎外观满意度，是治疗重型尿道下裂患儿的有效术式。

关键词: 尿道下裂, Byars分期术式, 尿道成形术, 回顾性队列研究, 儿童

Objective

To compare the clinical efficacy of modified Byars staged urethroplasty versus traditional procedure in pediatric patients with severe hypospadias.

Methods

A retrospective analysis was conducted on clinical data of 82 pediatric patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2023. Patients were divided into traditional group (31 cases, underwent traditional Byars procedure) and modified group (51 cases, underwent modified Byars procedure) according to surgical approaches. Based on the traditional procedure, the modified Byars technique added glansplasty in stage I and employed Y-shaped flap combined with glans tunnel technique for urethroplasty in stage II. Perioperative indicators, postoperative complication rates, and follow-up outcomes were compared between the two groups.

Results

There were no significant differences between the two groups in preoperative baseline characteristics, operative time, blood loss, and incidence of postoperative complications including urethrocutaneous fistula, urethral stricture, urethral diverticulum, and penile curvature (P>0.05). The incidence of coronal fistula and glanular dehiscence in the modified group were both 0%, significantly lower than 12.90% in the traditional group (P=0.008). The rate of orthotopic urethral orifice in the modified group was 100%, significantly higher than 83.9% in the traditional group (P=0.003). The Hypospadias Objective Penile Evaluation (HOPE) score for penile appearance satisfaction in the modified group was (8.75±0.15), significantly higher than (7.94±0.30) in the traditional group (P=0.010). The modified group achieved normal urethral orifice position with natural slit-like configuration and near-normal penile appearance.

Conclusion

Compared with traditional Byars staged procedure, the modified technique significantly reduces the risk of coronal fistula and glanular dehiscence, improves the rate of orthotopic urethral orifice and penile appearance satisfaction, representing an effective surgical approach for treating severe hypospadias in pediatric patients.

Key words: Hypospadias, Byars staged procedure, Urethroplasty, Cohort study, Pediatric patients

图1 重型尿道下裂患儿阴茎头成形术示意图注：a为V形切口；b为切除尿道沟处尿道板；c为缝合阴茎头两翼；箭头示详情

图2 改良Byars分期尿道成形术（二期）示意图注：a为Y型皮瓣切口示意图；b为采用Y型皮瓣尿道成形；c为建立阴茎头隧道；d为切口缝合（缝合后切口呈Y形，阴茎头及冠状沟无切口）；箭头示详情

表1 两组重型尿道下裂患儿基线资料比较

组别	例数	年龄[月，(±s)]	尿道开口[例(%)]			阴茎下曲[例(%)]
组别	例数	年龄[月，(±s)]	阴茎阴囊交界	阴囊	会阴	中度	重度
传统组	31	23.3±1.9	15 (48.39)	11 (35.48)	5 (16.13)	13 (41.94)	18 (58.06)
改良组	51	23.8±1.8	23 (45.10)	19 (37.26)	9 (17.65)	21 (41.18)	30 (58.82)
统计值		t=0.156	χ²=0.188			χ²=0.004
P值		0.876	0.910			0.999
组别	合并症[例(%)]		尿道缺损[cm，(±s)]	阴茎头宽度[mm，(±s)]	总体住院时间[d，(±s)]	术后住院时间[d，(±s)]
组别	阴囊分裂	阴茎阴囊转位	尿道缺损[cm，(±s)]	阴茎头宽度[mm，(±s)]	总体住院时间[d，(±s)]	术后住院时间[d，(±s)]
传统组	17 (54.84)	13 (41.94)	5.8±0.4	14.4±1.7	14.48±0.18	13.00±0.15
改良组	31 (60.78)	23 (45.10)	5.6±0.3	14.4±1.8	14.47±0.15	13.96±0.11
统计值	χ²=0.281	χ²=0.078	t=0.484	t=0.003	t=0.055	t=0.218
P值	0.648	0.822	0.629	0.976	0.956	0.828

表1 两组重型尿道下裂患儿基线资料比较

组别	例数	年龄[月，(±s)]	尿道开口[例(%)]			阴茎下曲[例(%)]
组别	例数	年龄[月，(±s)]	阴茎阴囊交界	阴囊	会阴	中度	重度
传统组	31	23.3±1.9	15 (48.39)	11 (35.48)	5 (16.13)	13 (41.94)	18 (58.06)
改良组	51	23.8±1.8	23 (45.10)	19 (37.26)	9 (17.65)	21 (41.18)	30 (58.82)
统计值		t=0.156	χ²=0.188			χ²=0.004
P值		0.876	0.910			0.999
组别	合并症[例(%)]		尿道缺损[cm，(±s)]	阴茎头宽度[mm，(±s)]	总体住院时间[d，(±s)]	术后住院时间[d，(±s)]
组别	阴囊分裂	阴茎阴囊转位	尿道缺损[cm，(±s)]	阴茎头宽度[mm，(±s)]	总体住院时间[d，(±s)]	术后住院时间[d，(±s)]
传统组	17 (54.84)	13 (41.94)	5.8±0.4	14.4±1.7	14.48±0.18	13.00±0.15
改良组	31 (60.78)	23 (45.10)	5.6±0.3	14.4±1.8	14.47±0.15	13.96±0.11
统计值	χ²=0.281	χ²=0.078	t=0.484	t=0.003	t=0.055	t=0.218
P值	0.648	0.822	0.629	0.976	0.956	0.828

表2 两组重型尿道下裂患儿手术情况比较

组别	例数	Ⅰ期		Ⅱ期
组别	例数	手术时间(min)	出血量(mL)	手术时间(min)	出血量(mL)
传统组	31	94.7±4.0	17.6±1.5	124.7±4.0	17.1±1.3
改良组	51	96.5±2.8	18.2±1.3	127.3±2.8	16.7±1.0
t值		0.361	0.319	0.532	0.256
P值		0.719	0.750	0.596	0.799

表2 两组重型尿道下裂患儿手术情况比较

组别	例数	Ⅰ期		Ⅱ期
组别	例数	手术时间(min)	出血量(mL)	手术时间(min)	出血量(mL)
传统组	31	94.7±4.0	17.6±1.5	124.7±4.0	17.1±1.3
改良组	51	96.5±2.8	18.2±1.3	127.3±2.8	16.7±1.0
t值		0.361	0.319	0.532	0.256
P值		0.719	0.750	0.596	0.799

图3 一例行改良Byars分期手术的阴囊型尿道下裂患者术前术后外观注：a为一期术前（箭头示窄尿道沟）；b为二期术前（箭头示尿道沟消失）；c为二期术后1年（箭头示正位开口，阴茎头尿道沟消失）；d为术后1年排尿（箭头示正位排尿、尿线粗大）

表3 两组重型尿道下裂患儿术后随访结果比较

组别	例数	尿瘘[例(%)]			尿道憩室[例(%)]	阴茎下曲[例(%)]	尿道狭窄[例(%)]	阴茎头裂开[例(%)]	正位开口[例(%)]	HOPE评分(±s)	随访时间[月，(±s)]
组别	例数	冠状沟	阴茎阴囊交界处	其他部位	尿道憩室[例(%)]	阴茎下曲[例(%)]	尿道狭窄[例(%)]	阴茎头裂开[例(%)]	正位开口[例(%)]	HOPE评分(±s)	随访时间[月，(±s)]
传统组	31	4 (12.90)	2 (6.45)	3 (9.68)	3 (9.68)	2 (6.45)	3 (9.68)	4 (12.90)	26 (83.88)	7.94±0.30	74±7
改良组	51	0 (0)	5 (9.80)	9 (17.65)	2 (3.92)	1 (1.96)	5 (9.80)	0 (0)	51 (100)	8.75±0.15	75±5
统计值		χ²=6.918	χ²=0.278	χ²=0.980	χ²=1.116	χ²=1.103	χ²<0.001	χ²=6.918	χ²=8.760	t=2.636	t=0.087
P值		0.008	0.598	0.322	0.291	0.294	0.985	0.008	0.003	0.010	0.931

表3 两组重型尿道下裂患儿术后随访结果比较

组别	例数	尿瘘[例(%)]			尿道憩室[例(%)]	阴茎下曲[例(%)]	尿道狭窄[例(%)]	阴茎头裂开[例(%)]	正位开口[例(%)]	HOPE评分(±s)	随访时间[月，(±s)]
组别	例数	冠状沟	阴茎阴囊交界处	其他部位	尿道憩室[例(%)]	阴茎下曲[例(%)]	尿道狭窄[例(%)]	阴茎头裂开[例(%)]	正位开口[例(%)]	HOPE评分(±s)	随访时间[月，(±s)]
传统组	31	4 (12.90)	2 (6.45)	3 (9.68)	3 (9.68)	2 (6.45)	3 (9.68)	4 (12.90)	26 (83.88)	7.94±0.30	74±7
改良组	51	0 (0)	5 (9.80)	9 (17.65)	2 (3.92)	1 (1.96)	5 (9.80)	0 (0)	51 (100)	8.75±0.15	75±5
统计值		χ²=6.918	χ²=0.278	χ²=0.980	χ²=1.116	χ²=1.103	χ²<0.001	χ²=6.918	χ²=8.760	t=2.636	t=0.087
P值		0.008	0.598	0.322	0.291	0.294	0.985	0.008	0.003	0.010	0.931

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Modified vs traditional Byars staged urethroplasty in pediatric patients with severe hypospadias: a cohort study

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Modified vs traditional Byars staged urethroplasty in pediatric patients with severe hypospadias: a cohort study