皮瓣点式缝合联合b FGF、胶原蛋白海绵对尿道下裂术后皮瓣愈合影响的研究

Curative efficacy of co-application of flap dot suturing,collagen sponge and basic fibroblast growth factor for preventing postoperative necrosis of hypospadias

目的探讨皮瓣点式缝合固定联合碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)、胶原蛋白海绵对尿道下裂术后皮瓣愈合的影响。方法收集2017年3月至2018年3月由天津市儿童医院收治的44例一期尿道成形的尿道下裂患儿作为试验组,所有患儿术中在缝合完毕后对腹侧覆盖尿道的皮瓣进行局部散在的透皮点式缝合,使皮瓣与皮下筋膜贴合,减少死腔。术后7 d左右拆除敷料联合应用bFGF与胶原蛋白,每日换药1次,观察皮瓣血运情况。随机选取2015年5月至2016年12月收治的44例一期尿道成形的尿道下裂患儿作为对照组,当时术中对转移至腹侧的皮瓣未行点式缝合,术后7 d拆除敷料后外涂红霉素眼膏护理创面。结果试验组经换药处理转移皮瓣血运恢复较佳,术后出现尿道瘘3例,尿瘘发生率为6.8%;对照组有10例出现尿瘘,尿瘘发生率为22.7%,差异有统计学意义(χ2=4.423,P<0.05)。试验组与对照组平均住院时间分别为(13.45±1.98)d和(15.23±1.68)d,差异有统计学意义(t=4.523,P<0.01)。两组患儿均未发生其他并发症。结论术中应用对腹侧覆盖尿道的转移皮瓣进行点式透皮缝合与深层筋膜固定可促进皮瓣与皮下筋膜贴合,减少死腔,改善皮瓣血运;术后联合应用bFGF及胶原蛋白海绵对创面的愈合有促进作用,疗效显著,缩短了住院时间。应用过程中未见全身及局部过敏反应及其他不良反应。

Objective To explore the characteristics and curative efficacy of co-application of dot suturing fixation on transposition flap,collagen sponge and basic fibroblast growth factor(bFGF)for preventing postoperative necrosis of hypospadias.Methods From March 2017 to March 2018,44 eligible hypospadias cases were selected.The same operative approach of straightening plus urethroplasty plus transplantation pedicled flap from dorsal part to ventral part for covering urethra plus posthioplasty was employed for research group.And,between May 2015 and December 2016,another 44 cases with similar characteristics were selected randomly as control group.In research group,suturing fixation was applied on transposition flap and wound covered with collagen sponge and bFGF after 1 week.Dressing was replaced daily for observing healing condition.In control group,dot suturing was skipped.After removing dressing,erythromycin eye ointment was smeared.Results In research group,vascular supply of transposition flap recovered better.There were only 3 cases of urethral fistula and the occurrence rate was 6.8%;In control group,urethral fistula(n=10)had an occurrence rate of 22.7%and the difference was statistically significant(P<0.05).And hospital stay of research and control groups were(13.45±1.98)and(15.23±1.68)days respectively and the difference was statistically significant(P<0.01).No other complications occurred.Conclusion Suturing fixation on transposition flap may eliminate dead space and improve flap vascular supply.Co-application of collagen sponge and bFGF can promote wound skin healing and shorten hospitalization stay.During the whole therapeutic process,there is no onset of anaphylactic or adverse reactions.