Xu Haihua,Xu Guodong,Zhang Fuyi,et al.Curative efficacy of co-application of flap dot suturing,collagen sponge and basic fibroblast growth factor for preventing postoperative necrosis of hypospadias[J].Journal of Clinical Pediatric Surgery,2019,18(12):1053-1056.[doi:10.3969/j.issn.1671-6353.2019.12.013]
皮瓣点式缝合联合bFGF、胶原蛋白海绵对尿道下裂术后皮瓣愈合影响的研究
- Title:
- Curative efficacy of co-application of flap dot suturing,collagen sponge and basic fibroblast growth factor for preventing postoperative necrosis of hypospadias
- Keywords:
- Hypospadias; Surgical Flaps; Suture Techniques; Collagen Sponge
- 分类号:
- R726.9;R695
- 摘要:
- 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。
- Abstract:
- 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.
参考文献/References:
1 Snodgrass WT,Bush NC.Hypospadias,Campbell-Walsh Urology[M].Philadelphia:Elsevier,2016:3399.
2 贾江华,齐进春,杜蕾,等.69例尿道下裂术后尿道狭窄的治疗经验分析[J].临床小儿外科杂志,2019,18(6):514-517.DOI:10.3969/j.issn.1671-6353.2019.06.015. Jia JH,Qi JC,Du L,et al.Diagnosis and treatment of urethral stricture after hypospadias operations:a report of 69 cases[J].J Clin Ped Sur,2019,18(6):514-517.DOI:10.3969/j.issn.1671-6353.2019.06.015.
3 李明勇,胡威,李清,等.尿道下裂TIP手术后尿瘘与手术年龄的相关性分析[J].临床小儿外科杂志,2017,16(5):451-454.DOI:10.3969/j.issn.1671-6353.2017.05.008. Li MY,Hu W,Li Q,et al.Relative study on age and the incidence of urinary fistula after hypospadias TIP[J].J Clin Ped Sur,2017,16(5):451-454.DOI:10.3969/j.issn.1671-6353.2017.05.008.
2 Zhao W,Han Q,Lin H,et al.Improved neovascularization and wound repair by targeting human basic fibroblast growth factor (bFGF) to fibrin[J].J Mol Med (Berl),2008,86(10):1127-1138.DOI:10.1007/s00109-008-0372-9.
3 HataY,Kawanabe H,HisanagaY,et al.Effacts of basic fibroblast growth factor administration on vascular changes in wound healing of ratpalates[J].Cleft Palate Craniofac J,2008,45(1):63-72.DOI:10.1597/06-166.1.
4 伊海英,孙晓艳,付小兵,等.碱性成纤维细胞生长因子的研究进展[J].解放军医学杂志,2008,33(6):776-778.DOI:10.3321/j.issn:0577-7402.2008.06.045. Yi HY,Sun XY,Fu XB,et al.Resaerch progress of the basic fibroblast growthfactor[J].Medical Journal of Chinese People’s Liberation Army,2008,33(6):776-778.DOI:10.3321/j.issn:0577-7402.2008.06.045.
5 覃凤均,陈旭,李迟.胶原蛋白海绵治疗II度烧伤创面的临床疗效研究[J].中国全科医学,2010,13(18):1994-1996.DOI:10.3969/j.issn.1007-9572.2010.18.015. Qin FJ,Chen X,Li C.Clinical curative effects evaluation of collagen sponge for II degree burn surface[J].Chinese General Practice,2010,13(18):1994-1996.DOI:10.3969/j.issn.1007-9572.2010.18.015.
6 Bektas CK,Kimiz I,Sendemir A,et al.A bilayer scaffold prepared from collagen and carboxymethyl cellulose for skin tissue engineering applications[J].J Biomater Sci Polym Ed,2018,29(14):1764-1784.DOI:10.1080/09205063.2018.1498718.
7 卫秀洋,王万明,陈勇忠,等.胶原蛋白海绵复合bFGF促进兔胫骨外露创面愈合的实验研究[J].中国医药指南,2012,10(23):399-401.DOI:10.3969/j.issn.1671-8194.2012.23.303. Wei XY,Wang WM,Chen YZ,et al.Basic fibroblast growth factor and collagen sponge improve rabbits skin wound healing with exposed tibia[J].Guide of China Medicine,2012,10(23):399-401.DOI:10.3969/j.issn.1671-8194.2012.23.303.
8 卞徽宁,陈华德,郑少逸,等.外源性碱性成纤维细胞生长因子对创面愈合病理变化的影响[J].感染、炎症、修复,2006,7(4):206-209.DOI:10.3969/j.issn.1672-8521.2006.04.004. Bian HN,Chen HD,Zheng SY,et al.An experimental study in wound healing with the application of exogenous basic fibroblast growth factor[J].Infection Inflammation Repair,2006,7(4):206-209.DOI:10.3969/j.issn.1672-8521.2006.04.004.
9 何军,雍江,尹智峰,等.尿道下裂患儿性激素水平的检测及意义[J].中国医师杂志,2016,18(11):1634-1636,1641.DOI:10.3760/cma.j.issn.1008-1372.2016.11.010. He J,Yong J,Yin ZF,et al.Detection of sex hormone levels in children with hypospadias[J].Journal of Chinese Physician,2016,18(11):1634-1636,1641.DOI:10.3760/cma.j.issn.1008-1372.2016.11.010.
10 张小明,何恢绪,胡卫列,等.生殖器皮瓣加盖在尿道下裂术后再次手术中的应用[J].中国医师杂志,2010,12(7):943-944.DOI:10.3760/cma.j.issn.1008-1372.2010.07.032. Zhang XM,He XH,Hu WL,et al.Application of genital flap covering in re-operations for hypospadias[J].Journal of Chinese Physician,2010,12(7):943-944.DOI:10.3760/cma.j.issn.1008-1372.2010.07.032.
相似文献/References:
[1]罗洪,孙德霞,强红家,等.不同部位皮肤再造尿道的病理学研究[J].临床小儿外科杂志,2010,9(06):443.
[2]丁勇,魏华,孔燕,等.横裁包皮岛状皮瓣法在尿道下裂治疗中的应用[J].临床小儿外科杂志,2010,9(06):474.
[3]景登攀张根领孙蔓丽.改良Snodgrass术治疗尿道下裂疗效观察[J].临床小儿外科杂志,2011,10(01):0.
[4]顾胜利 罗雪松. 阴茎腹侧皮瓣切除术治疗小儿隐匿阴茎[J].临床小儿外科杂志,2011,10(02):153.
[J].Journal of Clinical Pediatric Surgery,2011,10(12):153.
[5]陈俊杰,郭晓东,孙志南,等.应用带血管蒂包皮内板法治疗重度隐匿型阴茎[J].临床小儿外科杂志,2008,7(01):29.
[6]曹永胜,窦莹,蔡盈,等.改良Snodrass手术一期修复小儿尿道下裂25例[J].临床小儿外科杂志,2008,7(03):16.
[7]肖伟,高智勇.Snodgrass及Onlay island flap术式治疗小儿尿道下裂疗效对比分析[J].临床小儿外科杂志,2008,7(03):30.
[8]陈建兵,崔杰,王顺荣,等.皮下筋膜蒂皮瓣修复皮肤缺损47例报告[J].临床小儿外科杂志,2008,7(04):0.
[9]熊晶 刘颖 魏光辉 刘星 张德迎 吴盛德. HoxA13基因在尿道下裂胎鼠阴茎中的表达及意义[J].临床小儿外科杂志,2011,10(05):341.
[J].Journal of Clinical Pediatric Surgery,2011,10(12):341.
[10]周维 李娟 黄国显 陈海琛 胡杨 徐延波. Snodgrass及Mathieu术式治疗前型尿道下裂的对比分析[J].临床小儿外科杂志,2011,10(05):364.
[J].Journal of Clinical Pediatric Surgery,2011,10(12):364.
备注/Memo
收稿日期:2018-01-28。
通讯作者:徐国栋,Email:dongyan615@163.com