无缝合割包皮比标准程序安全有效


  October 12, 2006 (亚特兰大) —根据一篇新的研究发现,以2-氰基丙烯酸辛酯(2-octyl cyanoacrylate(2-OCA, Dermabond))进行无缝合割包皮,比标准缝合方式安全且更美观。
  
  Emory大学儿童健康照护的Andrew J. Kirsch医师和同事,在美国小儿科学会国际研讨会与展览发表其研究发现。
  
  研究者评估70位病患(平均年纪4岁)的无缝合手术方式,这些病患中, 59进行传统割包皮,11位接受使用2-OCA进行皮肤闭合的割包皮方式。
  
  以袖套法(n = 57)或宫扣夹(Gomco clamp)(n = 13)进行割包皮手术,止血后对切口进行第一次清洁,然后将两个皮肤层对准,接著,两薄层的2-OCA 盖住边缘,干燥后,用抗生素药膏治疗龟头和阴茎。
  
  整体平均皮肤密合时间是三分钟,但是最后的 20位病患的密合时间小于90 秒,显示医师的技术也随著经验改善;在平均3.4个月的追踪期之后,并无发现术中或术后并发症。
  
  根据研究者主观表示,外观方面也比传统手术者为佳,不会有缝合轨迹或窦缝,此外,父母亲也会对手术比较满意。
  
  Kirsch医师指出,无缝合割包皮并不适用于所有的病患,他向Medscape表示,若需要缝合或包扎才能止血或对齐组织的话,就不适合进行无缝合割包皮。
  
  Kirsch医师补充,此外,无缝合技术花费较高;不过,若可以每个病例都节省15分钟,这样的花费效益是可以理解的;至于两种方式之间的直接花费和结果的比较正在进行中。
  
  他指出,外观和没有缝合相关的伤口仍使额外的花费值得,我们已经在我们执业的地方让这一个新方法成为手术首选。
  
  丹佛儿童医院儿童泌尿科主任,Martin A. Koyle医师报告他自己在实务上使用无缝合割包皮;Koyle医师向Medscape表示,这是相当容易的技术,可作为目前耗时手术方式的替代选择;此外,我们也用此技术进行尿道下裂手术。
  
  他指出,不会用无缝合技术于包茎案例,我们个人的经验是阴茎会再掉回去,所以我们仅用此技术在传统的包皮适应症。
  
  作者报告并无任何财金关系。
  
  AAP 2006国际研讨会与展览:摘要 475。发表于 October 7, 2006。

Sutureless Circumcision Safe,<

By Emma Hitt, PhD
Medscape Medical News

October 12, 2006 (Atlanta) — Sutureless circumcision with 2-octyl cyanoacrylate (2-OCA, Dermabond) appears to be a safe and cosmetically appealing alternative to standard suturing, according to the findings of a new study.

Andrew J. Kirsch, MD, and colleagues from Emory University and Children's Health Care of Atlanta, Georgia, presented the findings here at the American Academy of Pediatrics National Conference and Exhibition.

The researchers evaluated the sutureless procedure in 70 patients (average age, 4 years). Of those, 59 underwent circumcision, and 11 underwent circumcision revision with the use of 2-OCA for skin closure.

Circumcision was conducted using a sleeve technique (n = 57) or a Gomco clamp (n = 13). The incision was first cleaned after hemostasis, and the 2 skin edges were aligned. Next, 2 thin layers of 2-OCA were applied to the edges and allowed to dry. The glans and penis were then treated with antibiotic ointment.

The average skin closure time was 3 minutes overall, but for the last 20 patients, the closure time was less than 90 seconds, indicating improved technique over time. After a mean follow-up of 3.4 months no intraoperative or postoperative complications were observed.

Subjectively, cosmetic outcomes appeared to be better than those observed with standard procedures, with no risk of suture tracks or sinuses, according to researchers. In addition, parents seemed to be satisfied with the procedure.

Dr. Kirsch pointed out that sutureless circumcision is not appropriate for all patients. "If sutures or dressings for hemostasis or tissue alignment are required, then sutureless circumcision is not appropriate," he told Medscape.

"In addition, the cost is higher with the sutureless technique; however, if 15 minutes can be saved per case, major cost benefits should be realized," Dr. Kirsch added. A direct cost and outcome comparison between the 2 techniques is underway.

"The cosmetic appearance and lack of suture-related wound healing issues still makes the additional small cost worthwhile, and [we] have made it our procedure of choice at our institution," he said.

Martin A. Koyle, MD, chief of pediatric urology at The Children's Hospital, in Denver, Colorado, reported using the sutureless circumcision technique in his practice. "It is a quick and easy technique and is an option to current delayed circumcision modes," Dr. Koyle told Medscape. "We have also used this technique for hypospadias as well," he said.

He noted that he would not use the sutureless technique in the case of a hidden penis. "We have personally had experience where the penis drops back again, and so we only use this technique for classical circumcision indications," he said.

The author reports no relevant financial relationships.

AAP 2006 National Conference & Exhibition: Abstract 475. Presented October 7, 2006.

    
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