摘要
目的探讨应用负压封闭引流技术(VSD)及湿性愈合技术在小儿尿道下裂治疗中的有效性及安全性。方法2015年1月至2017年1月郑州大学第一附属医院小儿泌尿外科收治尿道下裂Ⅲ度伴中重度阴茎下弯的患儿80例,年龄1岁6个月至12岁,按随机数字表法随机分为观察组和对照组,每组40例。80例患儿由同一位术者行阴茎下弯矫正术+一期尿道成形术(横裁包皮岛状皮瓣卷管术,Duckett术式),所有患儿术中均游离翻转阴囊中隔筋膜组织瓣覆盖加固于成形尿道。术毕观察组阴茎包裹软聚硅酮伤口接触层敷料(美皮贴)后安装VSD,术后生理盐水持续缓慢冲洗并低负压持续加压引流7 d,负压维持在-30^-20 kPa,液体滴速为每分钟7滴;对照组常规应用美皮贴、纱布及自粘型弹力绷带加压包扎7 d。2组打开VSD及包扎敷料后均常规碘伏消毒,于阴茎切口血痂处交替应用红霉素药膏涂抹及生理盐水纱布湿敷软化血痂使其尽快脱落,2组术后均常规留置F8硅胶尿管1个月。观察比较2组术后切口处血痂发生、血痂下感染、尿道瘘、尿道裂开、尿道狭窄等情况。使用SPSS 21.0统计软件进行数据处理,计数资料比较采用t检验,计量资料比较采用χ2检验,P<0.05为差异有统计学意义。手术成功评价标准为无尿道瘘、尿道狭窄、尿道裂开、尿道憩室等术后并发症,排尿通畅,无排尿困难。结果观察组患儿对VSD的耐受性良好,无VSD不良反应。术后7 d,阴茎敞开暴露后,观察组阴茎切口表面血痂发生率为20.0%(8/40),血痂下感染发生率为12.5%(5/40),均低于对照组的42.5%(17/40)和32.5%(13/40),差异均有统计学意义(χ2=4.713,P=0.030;χ2=4.588,P=0.032)。术后1个月拔除尿管后观察组发生尿道瘘5例,尿道狭窄1例,手术成功率85.0%(34/40);对照组发生尿道瘘9例,尿道裂开1例,尿道狭窄1例,手术成功率72.5%(29/40),观察组手术成功率高于对照组。结论小儿尿道下裂术后应用VSD持续生理盐水冲洗并低负压加压引流治疗效果满意并安全,能有效减少尿道下裂术后血痂的形成及血痂下感染的发生,有助于提高尿道下裂修复手术的成功率。
Objective To evaluate the efficacy and safety of vacuum sealing drainage(VSD)and moist healing technology in the treatment of hypospadias of children.Methods From January 2015 to January 2017,80 cases of children with proximal hypospadias and moderate or severe penile curvature from 1.5 years to 12 years old who received hypospadias operation were assigned into the study group(SG)(n=40)and control group(CG)(n=40),based on simple randomization.80 cases of children were done operation included correcting the penile curvature and urethroplasty(Duckett urethroplasty)by one surgeon,all of them were received the procedure covered the urethra by scrotal septum tissue.The cases of SG were installed VSD after covered soft polysilicone wound dressing(merlot),who underwent treatment of slowly flushing by saline solution(liquid drop,7 drops/min)and attracting by negative pressure(negative pressure range,from-30 kpa to-20 kpa)for 7 days.The cases of CG were bound up the penis with merlot,gauze and self-adhesive elastic bandage for 7 days.All cases of two group were sterilize by iodophor after opening dressing,smeared erythromycin ointment and applied hydropathic compress by wet gauze to help blood scab accelerate to drop,when blood scab appeared.All cases were conventionally reserved with F8 catheter for 1 month.The standard of successful operation was that there was no complication,included urethral fistula,urethral stenosis,urethral dehiscence,urethrocele and dysuresia.Results The children of SG were found to be well tolerated to VSD,there was no adverse reaction to VSD.7 days after operation,incidence of blood scab(20%,8/40)and rate of under-scab infection of SG(12.5%,5/40)were lower than CG[42.5%(17/40),32.5%(13/40)],the differences were statistically significant(χ2=4.713,P=0.030;χ2=4.588,P=0.032).1 month postoperation,urethral fistula 5 cases,urethral stenosis 1 case were found in SG,otherwise CG complications included urethral fistula 9 cases,urethral dehiscence 1 case and urethral stenosis 1 case.The success rate of surgery of SG was higher than CG[85(34/40)vs 72.5%(29/40)%].Conclusions Applying VSD continuously slowly flushing and extracting by negative pressure to hypospadias treatment is effective and safe,which could effectively reduce the blood scab formation and the rate of under-scab infection,which can increase the success rate of hypospadias surgery.
作者
郭立华
张谦
王磊
李骥
范应中
Guo Lihua;Zhang Qian;Wang Lei;Li Ji;Fan Yingzhong(Department of Pediatric Surgery,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2020年第2期180-184,共5页
Chinese Journal of Plastic Surgery
关键词
尿道下裂
负压封闭引流
湿性愈合
儿童
Hypospadias
Vacuum sealing drainage
Moist healing
Children
作者简介
通信作者:张谦,Email:sy110@sina.com。
