CAJ | 학술논문

目的对新手术张氏包皮环切术与包皮套扎术进行前瞻性随机对照研究,以了解新手术的安全性、疗效和并发症.方法 7～45岁包皮过长和包茎100例,随机分为两组,每组50例.试验组进行张氏包皮环切术;对照组进行包皮套扎术.比较两种术式手术时间、术中出血量、术后3d、7d及1个月随访,包括疼痛评估、创口完全愈合时间、术后严重并发症发生率(疼痛、伤口流脓、水肿、伤口裂开、二次手术)及围手术期费用等指标.结果试验组与对照组相比,初次手术时间分别为18±4min与8±3min(P＜0.05),但对照组46例(92％)二次回院咨询和39例(78％)三次回院拆环,对照组总治疗时间超过试验组(P＜0.05);试验组总体费用1192元,显著低于对照组的1384元(P＜0.05);术后康复时间7±2d与19±3d(P＜0.05),伤口愈合整齐;试验组与对照组严重并发症分别为,伤口流脓0例与50例(P＜0.05);伤口裂开0例与18例(P＜0.05),轻中度疼痛21例(44％)与中重度疼痛44例(88％)(P＜0.05);伤口轻度水肿8例(16％)与中重度伤口水肿46例(92％)(P＜0.05);术后出血4例(8％)与3例(6％)(P＞0.05);包皮血肿3例(6％)与0例(p＜0.05).试验组术后无需特殊护理,无需二次手术,5～10d患者可自行取掉敷料;对照组术后每日需要碘伏消毒护理数次,2周取环,3例套扎环事故,重新手术止血缝合,18例伤口裂开患者中3例行二次手术缝合,1例(2％)预留包皮过长.结论新手术张氏包皮环切术效果与包皮套扎术相当,但术后不需特殊护理,严重并发症发生率比套扎术显著降低,尤其是疼痛、流脓、伤口水肿程度显著减轻.尽管初次手术时间比套扎术长,但不需二次咨询和后续拆环,总体时间和费用低于套扎术.综合各方面指标,张氏包皮环切术显著优于包皮套扎术,值得推广.
목적 대신수술장씨포피배절술여포피투찰술진행전첨성수궤대조연구,이료해신수술적안전성、료효화병발증.방법 7～45세포피과장화포경100례,수궤분위량조,매조50례.시험조진행장씨포피배절술;대조조진행포피투찰술.비교량충술식수술시간、술중출혈량、술후3d、7d급1개월수방,포괄동통평고、창구완전유합시간、술후엄중병발증발생솔(동통、상구류농、수종、상구렬개、이차수술)급위수술기비용등지표.결과 시험조여대조조상비,초차수술시간분별위18±4min여8±3min(P＜0.05),단대조조46례(92％)이차회원자순화39례(78％)삼차회원탁배,대조조총치료시간초과시험조(P＜0.05);시험조총체비용1192원,현저저우대조조적1384원(P＜0.05);술후강복시간7±2d여19±3d(P＜0.05),상구유합정제;시험조여대조조엄중병발증분별위,상구류농0례여50례(P＜0.05);상구렬개0례여18례(P＜0.05),경중도동통21례(44％)여중중도동통44례(88％)(P＜0.05);상구경도수종8례(16％)여중중도상구수종46례(92％)(P＜0.05);술후출혈4례(8％)여3례(6％)(P＞0.05);포피혈종3례(6％)여0례(p＜0.05).시험조술후무수특수호리,무수이차수술,5～10d환자가자행취도부료;대조조술후매일수요전복소독호리수차,2주취배,3례투찰배사고,중신수술지혈봉합,18례상구렬개환자중3례행이차수술봉합,1례(2％)예류포피과장.결론 신수술장씨포피배절술효과여포피투찰술상당,단술후불수특수호리,엄중병발증발생솔비투찰술현저강저,우기시동통、류농、상구수종정도현저감경.진관초차수술시간비투찰술장,단불수이차자순화후속탁배,총체시간화비용저우투찰술.종합각방면지표,장씨포피배절술현저우우포피투찰술,치득추엄.
Objectives Prospective randomized comparative study on Zhang's novel circumcision with loop ligature was carried out to investigate safety,effectiveness and complications of the novel operation.Methods 100 patients with redundant prepuce and phimosis aging from 7 to 45 years old were randomly grouped(divided) into two groups of 50 patients each.The patients in the experimental group were subject(subjected) to Zhang's novel circumcision while those in the control group took loop ligature.Parameters such as operation time,hemorrhage during operation,follow-ups of 3 days,7 days and t month post operation,including pain assessment,time of complete wound heal,occurrence of serious post operation complications (pain,wound suppuration,edema,wound rupture,secondary operation) and cost during the operation were compared.Results First operation time for the experimental and control groups was 18 ±4 mins and 8 ±3 mins,respectively(P ＜0.05),however,46(92％) and 39(78％) patients of the control group came back to the hospital for consulting or loop removing,respectively.Total treating time and cost of the control group was significantly higher than the experimental group(P ＜ 0.05);significantly lower than the control group (1192 Yuan vas 1384 Yuan,P ＜ 0.05);post operation recovery time was 7 ± 2 days and 19 ± 3 days,respectively(P ＜ 0.05),with neat healing of the wound;Complications for the experimental group and control group was0 and50 wound suppuration (P ＜0.05);0 and 18 wound rupture(P ＜0.05);21 (44％) mild to moderate pain and 44 (88％) moderate and severe pain(P ＜0.05);8 (16％) mild edema and 21 (44％) moderate and severe edema;4 (8％) and 3 (6％) post operation hemorrhage(P ＞0.05);3 (6％) and 0 (0％)foreskin hematoma(P ＜0.05),respectively.The experimental group did not require special post operation care or secondary operation,and the patients could remove the dressing by themselves after 5 to 10 days;the control group required several iodophor treatment everyday before removing the loop two weeks later.3 cases of loop accident required operative sewing.In the 18 patients with wound rupture,3 underwent secondary operation sewing,1 (2％) had redundant foreskin remained.Conclusions Zhang's novel circumcision has similar effect with the loop ligature,but it does not require special post operation care,and had significantly decreased occurrence rate of serious complications,especially pain,suppuration and edema.Although first operation requires longer time than the loop ligature,no secondary consulting or later loop removal is required and the total cost and time are lower than the loop ligature.Taking multiple parameters into consideration,Zhang's novel circumcision is better than the loop ligature and is worth spreading.