Outcome of Hypospadias Reoperation Based on Preoperative Antimicrobial Prophylaxis

術前使用預防性抗生素對尿道下裂再次手術結果之影響

李永進(Yung-Chin Lee) ； 黃俊雄(Chun-Hsiung Huang) ； 周以和(Yii-Her Chou) ； 林釗佑(Chao-Yu Lin) ； 吳文正(Wen-Jeng Wu)

《The Kaohsiung Journal of Medical Sciences》 21卷8期 (2005/08) Pp. 351-357

摘要

從1981年8月到2004年6月，我們以回溯性的方式回顧66位尿道下裂患者接受的123次手術。藉以分析術前給予預防性抗生素的有無，對於患者再次接受手術時之影響結果。所有患者均是在本院接受尿道下裂的首次手術。所有手術均給予術後預防性抗生素。我們定義手術為無廔管矯治是指：至少有兩週以上之記錄且術後追蹤並未有尿道皮膚廔管或傷口完全脫線情形。123次手術包括66個首次手術及57個再次手術。所有患者接受首次手術時的平均年齡為4年4個月大。整體無廔管矯治率是53% (35/66)。平均追蹤時間為14個月。88次手術失敗的原因：有67次(76%)是廔管，21次(24%)是傷口脫線。三種型態的尿道下裂中，以冠狀下型尿道下裂修補的無廔管矯治率(81.0%)較高(P=0.02)。在首次手術中，以兩階段式修補術的無廔管矯治率最低(12.5%)。然而，這些病人在接受再次手術時，卻明顯擁有較高的無廔管矯治率(66.7%, P=0.043)。123次的手術中，僅46次(37%)手術有給予術前預防性抗生素。不管是首次或再次手術，給予術前預防性抗生素均擁有較低的早期併發症率（42.3%比52.5%與40.0%比54.1%）。不過，這種差異並未達到統計學上的顯著意義（P=0.231和0.289）。另外，於再次手術中給予術前預防性抗生素(57.1%)比那些不給予的擁有較高的無廔管矯治率(23.15)。這種差異則達到統計學上的顯著意義。由本研究的資料指出：尿道下裂再次手術中給予術前預防性抗生素，擁有較低的早期併發症率與較高的無廔管矯治率。這類的患者，我們建議術前給予廣效性抗生素。不過，在提出更廣泛性的結論前，我們還需要更精確且前瞻性的研究來評估這個結果。

關鍵字

尿道下裂 ； 再次手術 ； 預防性抗生素

並列摘要

From August 1981 to June 2004, we retrospectively reviewed 66 hypospadias, treated with 123 operations, to analyze the outcome of reoperation based on preoperative antimicrobial prophylaxis. All patients received primary treatment in our hospital, and all had postoperative antimicrobial prophylaxis in all surgical procedures. We define a hypopadias repair as ”corrected without fistula” if no urethrocutaneous fistula formation, or complete wound disruption is found within at least a 2-week follow-up period. Of the 123 operations, there were 66 primary repairs and 57 reoperations. The mean age at primary repair was 4.33 years. The overall rate of correction without fistula was 53.0% (35/66), with a mean of 14 months, follow-up. A total of 88 failure repairs resulted from 67 (76.0%) fistulas and 21 (24.0%) disruptions. A higher rate of correction without fistula (81.0%) was related to subcoronal hypospadias (p=0.020) in three types. The rate of correction without fistula of two-staged repair was lowest in primary operations (12.5%), but these cases had a significantly higher rate of correction without fistula in following reoperations (66.7%, p=0.043). Of the 123 repairs, only 46 (37%) had preoperative antibiotic prophylaxis, and these had lower early complication rates, both in primary and reoperation groups (42.3% vs 52.5% and 40.0% vs 54.1%, respectively). The differences, however, were not statistically significant (p=0.231 and p=0.289, respectively). In terms of rate of correction without fistula, a higher rate of correction without fistula was observed in reoperations with preoperative antibiotic prophylaxis (57.1%), compared to those without prophylaxis (23.1%). This difference was statistically significant (p=0.031). The data from this study suggest that a lower early complication rate and a significantly higher rate of correction without fistula are related to the hypospadias reoperations with preoperative antimicrobial prophylaxis. The use of broad-spectrum antibiotics before surgery is recommended for these cases. However, more precise and prospective studies are warranted.

並列關鍵字

hypospadias ； reoperation ； antimicrobial prophylaxis