尿道下裂术后尿路感染的原因及治疗分析
王学军,陈月娇,毛 宇,唐耘熳,陈绍基,覃道锐,刘 茂,郑杰文

四川省医学科学院·四川省人民医院、电子科技大学附属医院儿童医学中心小儿外科(四川省成都市,610072),

尿道下裂; 手术后并发症; 感染; 畸形

Causes and management of urinary tract infections after hypospadias surgery.
Wang Xuejun, Chen Yuejiao, Mao Yu, Tang Yunman, Chen Shaoji, Qin Daorui, Liu Mao, Zheng Jiewen.

Department of Pediatric Surgery,Children's Medical Center,Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital; Affiliated Hospital,University of Electronic Science & Technology of China,Chengdu 610072,China.Corresponding author: Tang Yunman,E-mail: tangyunman@126.com

Hypospadias; Postoperative Complications; Infection; Abnormalities

DOI: 10.3969/j.issn.1671-6353.2017.03.0.07

备注

目的 探讨尿道下裂术后尿路感染的原因及处理措施。 方法 本院于2012年1月至2016年6月期间收治尿道下裂术后尿路感染病例44例,年龄1岁10个月至25岁,平均7岁6个月。均完善相关检查确定尿路感染原因,在有效抗生素的合理应用下,采用相应措施对因治疗。 结果 全部病例尿液培养以G — 杆菌为主。41例存在单一致感因素,尿道狭窄排在首位,此外还有合并先天性畸形以及膀胱直肠功能障碍等少见感染危险因素; 有3例尿路感染是上述致感因素综合作用的结果。在对因处理中,对27例尿道狭窄予手术解除梗阻,1例定期探条扩张; 5例前列腺囊予手术切除或造口,6例坚持前列腺囊按摩; 3例膀胱输尿管反流予口服抗生素保守治疗; 2例后尿道瓣膜切开; 4例加强直肠膀胱功能训练控制相关尿感。44例中,失访3例,其余随访1～54个月,平均21个月,其中保守治疗的2例膀胱输尿管反流、3例前列腺囊、2例单纯残余尿增多患者仍存在反复尿路感染。 结论 尿道下裂术后尿路感染的病因具有多样性,尿道狭窄排在首位,应注意评估综合致感因素并进行针对性治疗。
Objective To explore the causes and managements of urinary tract infections after hypospadias surgery. Methods From January 2012 to June 2016,44 patients with urinary tract infections after hypospadias surgery were recruited and their clinical data analyzed retrospectively. The mean age was 90(10～300)months. Causative factors were assessed through auxiliary examinations. Antibiotic therapy was based on micropathogenic examinations and the relevant causative factors were targeted accordingly. Results Micropathogens were noted predominantly as gram-negative bacilli. Single causative factor was detected in 41 patients of urethral stricture with associated congenital urinary anomalies. In 3 patients,there were complicated causative factors. Urethral stricture was managed with surgical correction in 27 patients and routine urethral dilation in another. For 11 patients with utricle,surgical removal or utricostomy was indicated in 5 and regular prostate massage for the remainder. Therapeutic or prophylactic antibiotics was prescribed for 3 patients with vesicoureteral reflux(VUR). Transurethral resection was effective for 2 patients with posterior urethral valve. Rehabilitation training was applied uneventfully for 4 patients with bladder-bowel dysfunction. During a mean follow-up period of 21(1-54)months,3 patients were lost. Recurrent infection was noted in 7 patients with conservative therapy including VUR(n=2),utricle(n=3)and simple elevated postvoiding residue(n=2). Conclusion s The causes of postoperative UTI are diverse after hypospadias surgery. And urethral stricture is a prominent risk factor. Comprehensive targeted therapy is preferred.