目的:探讨气膀胱腹腔镜Cohen手术治疗输尿管末端疾病的疗效.方法:回顾分析2011年5月至2021年12月收治的膀胱输尿管反流及输尿管末端梗阻患儿的临床资料.患儿均行输尿管膀胱再植手术,根据手术入路分为开放组(n=48)与气膀胱腹腔镜组(气膀胱组,n=70),对比分析两组手术时间、切口长度、术后肉眼血尿时间、住院时间、肾输尿管积水恢复情况、术后并发症、再手术率等指标.结果:两组患儿年龄、体重、疾病类型、肾输尿管积水严重程度等差异均无统计学意义.与开放组相比,气膀胱组应用血制品少(P=0.001)、切口长度短(P<0.001)、黏膜下隧道与输尿管末端直径比大(P=0.001)、术后肉眼血尿时间短(P=0.005)、术后留置尿管时间短(P=0.023)、术后住院时间短(P<0.001),但手术时间长(P<0.001).两组患儿术后肾输尿管积水情况均明显改善,气膀胱组较开放组肾盂积水改善更明显(P=0.035).两组术后应用止疼药、住院期间泌尿系统感染发生率、术后反流与再梗阻、长期排尿异常及再次手术率差异无统计学意义.结论:治疗输尿管末端疾病,气膀胱腹腔镜Cohen手术相较传统开放手术具有美观、损伤小、术后康复快的优点,是安全、有效并值得推广的术式.

Objective:To evaluate the cosmetic outcomes of hypospadias repair with pediatric penile perception score (PPPS) by parents and children and explore the risks facfors for PPPS results.Methods:A retrospective analysis was performed for hypospadiacs operated from January 2012 to December 2021.Parents and children aged over 10 years were surveyed by a questionnaire of PPPS.Surgical data of previous repair and postoperative follow-ups were recorded.Surgical data included surgical age, duration of follow-up, age at follow-up, preoperative meatal location, preoperative glan width, penile curvature before/after degloving, surgical procedure, dorsal plication, multiple operations, staged repair, postoperative glan width, postoperative distance between meatus and corona, postoperative penile length, postoperative complications and the presence of complications during follow-up.The postoperative PPPS results were analyzed.Results:A total of 110 questionnaires from parents and 27 questionnaires from children were collected.High score group was defined by PPPS≥12 points.The total PPPS score of 110 parents and 27 children was 13.07±3.2 and 13.15±3.99 points respectirely, and the score for penis length wasthe lowesf.Among the 27cases evaluated by both patients and parents, there was no statistical difference in scores( P=0.986). Based upon parental scores from 77 cases with defailed operative records, they were assigned into two groups of high score ( n=64) and low score ( n=13). In univariate analysis, preoperative glan width[14.25(13.00, 16.00) vs.13.50(12.25, 14.00) mm], postoperative glan width[13.00(11.13, 14.00) vs.11.50(10.50, 12.75) mm] and penile length[36.00(34.25, 40.00) vs.35.00(31.00, 35.00)mm], postoperative complications[45% vs.85%] and current complications[19% vs.69%] had significant inter-group differences.Multiple Logistic regression revealed that current complications ( OR=5.401, 95% CI: 1.170~24.927) were the independent risk factors of unsatisfactory cosmetics ( P<0.05). Conclusion:The overall PPPS scores of both parents and children are satisfactory and consistent after hypospadias repair.And the presence of complications during follow-up is an independent risk factor of parental PPPS results.