DiSandro M, Palmer J M
Department of Urology, University of California, Davis, School of Medicine, Sacramento 95817, USA.
J Pediatr Surg. 1996 Jul;31(7):881-4. doi: 10.1016/s0022-3468(96)90402-9.
To report the complication rates after hypospadias surgery, with stratification according to the type of suture used for the urethral anastomosis (rapid/intermediate absorbable v prolonged absorbable.)
During a 7-year period (1986 to 1992), 117 boys aged 5 to 124 months (mean, 14) underwent surgical correction of hypospadias. The urethral anastomoses were performed with chromic sutures before 1987 (n = 15), with polydioxanone (PDS) between 1987 and 1990 (n = 46), and with polyglycolic acid (PgA) after 1990 (n = 56). The patients were separated into two groups: those whose operations were performed before 1987 and after 1990 (using chromic or PgA sutures), and those whose surgery occurred in the intervening 3 years (using PDS). A successful result was defined as good cosmesis without urethral stricture or urethrocutaneous fistula on long-term follow up (mean follow-up period, 15.9 months).
Of the cases that had PgA or chromic sutures, 76.1% were corrected in a single operation, as opposed to 50.9% when PDS was used (P = .002). In the chromic/PgA group, 6.8% had strictures, compared with 23.6% of the PDS group (P < .02). This contrast was most evident in cases with pedicled tube flaps; strictures occurred in 43.8% of the PDS group but in only 9.5% of the chromic/ PgA group (P < .02). There was no significant difference in the incidence of postoperative fistulas between the two groups. In some patients, the PDS sutures remained present in the urethra, without absorption, up to 7 months after the initial repair.
Sutures with rapid or intermediate absorption rates provide the best results for hypospadias surgery. The extreme delay in in vivo absorption of polydioxanone should preclude its use as an interrupted suture in small-caliber urethral anastomoses.
报告尿道下裂手术后的并发症发生率，并根据尿道吻合所用缝线类型（快速/中度可吸收与长效可吸收）进行分层分析。
在7年期间（1986年至1992年），117名年龄在5至124个月（平均14个月）的男孩接受了尿道下裂手术矫正。1987年以前（n = 15）尿道吻合采用铬制缝线，1987年至1990年期间（n = 46）采用聚二氧杂环己酮（PDS）缝线，1990年以后（n = 56）采用聚乙醇酸（PgA）缝线。患者被分为两组：手术在1987年以前和1990年以后进行的患者（使用铬制或PgA缝线），以及手术在中间3年进行的患者（使用PDS缝线）。成功的结果定义为长期随访（平均随访期15.9个月）时外观良好，无尿道狭窄或尿道皮肤瘘。
使用PgA或铬制缝线的病例中，76.1%在一次手术中得到矫正，而使用PDS缝线时这一比例为50.9%（P = 0.002）。在铬制/PgA组中，6.8%出现狭窄，而PDS组为23.6%（P < 0.02）。这种差异在带蒂皮管瓣病例中最为明显；PDS组中43.8%出现狭窄，而铬制/PgA组仅为9.5%（P < 0.02）。两组术后瘘的发生率无显著差异。在一些患者中，PDS缝线在初次修复后长达7个月仍未在尿道内吸收。
快速或中度吸收率的缝线在尿道下裂手术中效果最佳。聚二氧杂环己酮在体内吸收的极度延迟使其不应作为小口径尿道吻合的间断缝线使用。
