Wang Hui,Xie Hua,Kang Yulin,et al.Effect of circumcision or continuous antibiotic prophylaxis on lowering the recurrence rate of febrile urinary tract infection in boys with primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2022,21(11):1057-1061.[doi:10.3760/cma.j.cn101785-202207053-011]
包皮环切术与持续抗生素预防治疗对于降低男童原发性膀胱输尿管反流发热性尿路感染复发率的效果研究
- Title:
- Effect of circumcision or continuous antibiotic prophylaxis on lowering the recurrence rate of febrile urinary tract infection in boys with primary vesicoureteral reflux
- Keywords:
- Vesico-Ureteral Reflux; Child; Circumcision; Male; Antibiotic Prophylaxis
- 摘要:
- 目的 探讨包皮环切术与持续抗生素预防治疗对于降低原发性膀胱输尿管反流男童发热性尿路感染复发率的效果。方法 回顾性分析2017年6月至2020年6月于上海市儿童医院确诊的88例男性原发性膀胱输尿管反流患儿临床资料。入组患儿年龄10.2（5.9，17.9）个月，按不同治疗方式分为等待观察组（3例）、持续抗生素预防组（50例）、包皮环切术组（22例）以及持续抗生素预防+包皮环切术组（13例）。随访1~3年，统计各组发热性尿路感染复发情况。结果 88例患儿中发热性尿路感染复发率为23.9%（21/88），其中等待观察组3例中复发2例、持续抗生素预防组50例中复发16例，包皮环切术组复发率为22例中复发3例，持续抗生素预防+包皮环切术组无一例复发；4组复发率差异具有统计学意义（χ2=10.181，P=0.011）。析因分析结果提示，行包皮环切术是降低原发性膀胱输尿管反流患儿发热性尿路感染复发率的主要因素（P=0.003）。结论 对于原发性膀胱输尿管反流男童，包皮环切术联合持续抗生素预防治疗可最大程度减少发热性尿路感染复发，包皮环切术在降低复发率中发挥主要作用；单纯持续抗生素预防的使用与等待观察对于降低发热性尿路感染复发率的效果无明显差异。
- Abstract:
- Objective To explore the effect of circumcision and continuous antibiotic prophylaxis on lowering the recurrence rate of febrile urinary tract infection in boys with primary vesicoureteral reflux.Methods From June 2017 to June 2020, clinical data were retrospectively reviewed for 88 boys with primary vesicoureteral reflux.The median age was 10.2(5.9, 17.9) months.They were assigned into four groups of watchful waiting (n=3), continuous antibiotic prophylaxis (n=50), circumcision (n=22) and continuous antibiotic prophylaxis plus circumcision (n=13).The follow-up period was 1 to 3 years.The recurrence of febrile urinary tract infection in each group was recorded and the effective conservative strategy analyzed.Results Among them, there were 21 cases (23.9%) of febrile urinary tract infection recurrence, 2 cases in watchful waiting group, 16 cases in continuous antibiotic prophylaxis group and 3 cases in circumcision group.No recurrence was noted in continuous antibiotic prophylaxis plus circumcision group.Statistical differences existed in recurrence rate among 4 treatment groups (χ2=10.181, P=0.011).Factorial analysis indicated that circumcision was a major factor in lowering the recurrence of febrile urinary tract infections (P=0.003).Conclusion For boys with primary vesicoureteral reflux, circumcision plus continuous antibiotic prophylaxis may prevent the recurrence of febrile urinary tract infection and circumcision plays a major role.No significant difference exists between continuous antibiotic prophylaxis and watchful waiting groups in lowering the recurrence rate of febrile urinary tract infection.
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备注/Memo
收稿日期:2022-07-28。
基金项目:上海市卫生和计划生育委员会项目（201840136）；转化医学国家重大科技基础设施（上海）开放课题（TMSK—2020—104）
通讯作者:黄轶晨,Email:drhuangyichen@163.com