Grobbelaar A O, Laing J H, Harrison D H, Sanders R
Department of Plastic Surgery, RAFT Institute of Plastic Surgery Research and Education, Mount Vernon Hospital, Middlesex, England.
Ann Plast Surg. 1996 Dec;37(6):612-7.
More than 200 surgical techniques have been advocated for hypospadias repair and perfection is still eluding us. The purpose of this paper is not to comment on a surgical technique, but to highlight the importance of postoperative care on the eventual surgical outcome. Two hundred six children undergoing primary hypospadias surgery from 1984 to 1994 at Mount Vernon Hospital were analyzed. The mean age of surgery was 3.8 years (range, 8 months-17 years) and our mean follow-up was 6.1 years. Various surgical techniques were used. During 1989, we changed our postoperative regime and patients were mobilized early (within 48 hours) compared to the strict-bed rest-till-catheter-out regime before 1988. This significantly reduced our fistula rate from 22% to 9.8% (chi squared p = 0.0016). Patient factors such as pulling on the catheter, urinary obstruction/blocked catheter, erections, straining due to constipation, and interference with dressings influence surgical outcome negatively. One of these patient factors was documented in all of our 33 patients who developed fistulas. In 6 patients (3.5%), a patient factor was present without any complication. This is highly significant statistically (chi squared p < 0.0001). The type of urinary diversion, period of urinary diversion, type of dressing, catheter size, and anesthetic regime did not influence outcome significantly.
已有200多种手术技术被推荐用于尿道下裂修复，但我们仍未实现完美修复。本文的目的不是对某种手术技术进行评论，而是强调术后护理对最终手术结果的重要性。对1984年至1994年在弗农山医院接受一期尿道下裂手术的206例患儿进行了分析。手术的平均年龄为3.8岁（范围8个月至17岁），平均随访时间为6.1年。采用了各种手术技术。1989年，我们改变了术后方案，与1988年以前严格卧床直至拔除导尿管的方案相比，患者在术后早期（48小时内）即可活动。这使我们的瘘管发生率从22%显著降低至9.8%（卡方检验p = 0.0016）。患者因素，如拉扯导尿管、尿路梗阻/导尿管堵塞、勃起、因便秘用力以及对敷料的干扰，会对手术结果产生负面影响。在我们所有发生瘘管的33例患者中均记录到了其中一种患者因素。在6例患者（3.5%）中，存在患者因素但未出现任何并发症。这在统计学上具有高度显著性（卡方检验p < 0.0001）。尿流改道的类型、尿流改道的时间、敷料类型、导尿管尺寸和麻醉方案对结果没有显著影响。
