PDF(Pubmed)
Abstract：
OBJECTIVE: Triclosan is an antiseptic substance that has been shown in preclinical studies to reduce bacterial load in the wound and slow bacterial growth by inhibiting fatty acid synthesis. It is claimed that the coating protects against colonization of the tissue around the suture. This study aimed to compare the safety and efficacy of triclosan-coated polydioxanone versus uncoated polydioxanone sutures for the prevention of surgical site infections (SSIs) following hypospadias repair in children.
METHODS: The medical records of 550 children who underwent hypospadias repair between 1 January 2014 and 31 December 2023 were retrospectively analyzed. The patients included in the study were divided into two groups. The first group consisted of the patients in whom polydioxanone (PDS II) was used (n = 262), while in the patients of the second group (n = 288), triclosan-coated polydioxanone (PDS Plus) was used for hypospadias repair. Secondary outcomes were defined as the occurrence of early and late complications, the number of readmissions within 30 days after surgery (ReAd), unplanned return to the operating room (uROR), and repeat operations.
RESULTS: The median age of all children enrolled in the study was 16 (IQR 14, 20) months. The patients in whom PDS Plus was used for hypospadias repair had a significantly lower number of SSIs than the patients in whom PDS II was used (n = 18 (6.9%) vs. n = 4 (1.4%), p < 0.001). Wound infection led to wound dehiscence in 10 of 18 patients from the PDS II group, while all four wound infections from the PDS Plus group led to wound dehiscence (p = 0.07). The number of postoperative urethrocutaneous fistulas was significantly lower in the patients in whom PDS Plus was used (13.7% vs. 8.3%, p = 0.042). The incidence of late complications did not differ between the study groups: meatal stenosis (p = 0.944), residual chordee (p = 0.107), urethral stricture (p = 0.196), scarring (p = 0.351) and urinary discomfort (p = 0.713). There were no cases of uROR in either group. The ReAd rate was low in both groups (n = 5 (1.9%) vs. n = 2 (0.6%), p = 0.266). The frequency of reoperations was lower in the group of patients treated with PDS Plus than in the group of patients treated with PDS II (11.1% vs. 20.6%; p = 0.03).
CONCLUSIONS: The use of PDS Plus in hypospadias surgery significantly reduces the incidence of SSI, postoperative fistulas, and reoperation rates compared to PDS II.
METHODS: The medical records of 550 children who underwent hypospadias repair between 1 January 2014 and 31 December 2023 were retrospectively analyzed. The patients included in the study were divided into two groups. The first group consisted of the patients in whom polydioxanone (PDS II) was used (n = 262), while in the patients of the second group (n = 288), triclosan-coated polydioxanone (PDS Plus) was used for hypospadias repair. Secondary outcomes were defined as the occurrence of early and late complications, the number of readmissions within 30 days after surgery (ReAd), unplanned return to the operating room (uROR), and repeat operations.
RESULTS: The median age of all children enrolled in the study was 16 (IQR 14, 20) months. The patients in whom PDS Plus was used for hypospadias repair had a significantly lower number of SSIs than the patients in whom PDS II was used (n = 18 (6.9%) vs. n = 4 (1.4%), p < 0.001). Wound infection led to wound dehiscence in 10 of 18 patients from the PDS II group, while all four wound infections from the PDS Plus group led to wound dehiscence (p = 0.07). The number of postoperative urethrocutaneous fistulas was significantly lower in the patients in whom PDS Plus was used (13.7% vs. 8.3%, p = 0.042). The incidence of late complications did not differ between the study groups: meatal stenosis (p = 0.944), residual chordee (p = 0.107), urethral stricture (p = 0.196), scarring (p = 0.351) and urinary discomfort (p = 0.713). There were no cases of uROR in either group. The ReAd rate was low in both groups (n = 5 (1.9%) vs. n = 2 (0.6%), p = 0.266). The frequency of reoperations was lower in the group of patients treated with PDS Plus than in the group of patients treated with PDS II (11.1% vs. 20.6%; p = 0.03).
CONCLUSIONS: The use of PDS Plus in hypospadias surgery significantly reduces the incidence of SSI, postoperative fistulas, and reoperation rates compared to PDS II.
摘要：
目的：三氯生是一种抗菌物质，已在临床前研究中证明可通过抑制脂肪酸合成来减少伤口中的细菌负荷并减缓细菌生长。据称,涂层防止缝合线周围的组织定植。这项研究旨在比较三氯生涂层聚二恶烷酮与未涂层聚二恶烷酮缝线预防儿童尿道下裂修复后手术部位感染（SSIs）的安全性和有效性。
方法：回顾性分析了在2014年1月1日至2023年12月31日期间接受尿道下裂修复的550名儿童的病历。将纳入研究的患者分为两组。第一组包括使用聚二恶烷酮（PDSII）的患者（n=262），而第二组患者（n=288），三氯生涂层聚二恶烷酮（PDSPlus）用于尿道下裂修复。次要结局定义为早期和晚期并发症的发生。手术后30天内再入院的次数（ReAd），计划外返回手术室(uROR)，并重复操作。
结果：参与研究的所有儿童的中位年龄为16(IQR14,20)个月。使用PDSPlus进行尿道下裂修复的患者的SSI数量明显低于使用PDSII的患者（n=18（6.9％）与n=4（1.4%），p<0.001)。PDSII组18例患者中有10例伤口感染导致伤口裂开，而PDSPlus组的所有四种伤口感染均导致伤口裂开（p=0.07）。使用PDSPlus的患者术后尿道瘘的数量显着降低（13.7％vs.8.3%,p=0.042)。晚期并发症的发生率在研究组之间没有差异：气孔狭窄（p=0.944），残余和弦（p=0.107），尿道狭窄（p=0.196），结疤（p=0.351）和尿路不适（p=0.713）。两组均无uROR病例。两组的ReAd率均较低（n=5（1.9％）与n=2（0.6%），p=0.266）。用PDSPlus治疗的患者组的再手术频率低于用PDSII治疗的患者组（11.1％vs.20.6%；p=0.03）。
结论：在尿道下裂手术中使用PDSPlus可显著降低SSI的发生率，术后瘘,和与PDSII相比的再手术率。
方法：回顾性分析了在2014年1月1日至2023年12月31日期间接受尿道下裂修复的550名儿童的病历。将纳入研究的患者分为两组。第一组包括使用聚二恶烷酮（PDSII）的患者（n=262），而第二组患者（n=288），三氯生涂层聚二恶烷酮（PDSPlus）用于尿道下裂修复。次要结局定义为早期和晚期并发症的发生。手术后30天内再入院的次数（ReAd），计划外返回手术室(uROR)，并重复操作。
结果：参与研究的所有儿童的中位年龄为16(IQR14,20)个月。使用PDSPlus进行尿道下裂修复的患者的SSI数量明显低于使用PDSII的患者（n=18（6.9％）与n=4（1.4%），p<0.001)。PDSII组18例患者中有10例伤口感染导致伤口裂开，而PDSPlus组的所有四种伤口感染均导致伤口裂开（p=0.07）。使用PDSPlus的患者术后尿道瘘的数量显着降低（13.7％vs.8.3%,p=0.042)。晚期并发症的发生率在研究组之间没有差异：气孔狭窄（p=0.944），残余和弦（p=0.107），尿道狭窄（p=0.196），结疤（p=0.351）和尿路不适（p=0.713）。两组均无uROR病例。两组的ReAd率均较低（n=5（1.9％）与n=2（0.6%），p=0.266）。用PDSPlus治疗的患者组的再手术频率低于用PDSII治疗的患者组（11.1％vs.20.6%；p=0.03）。
结论：在尿道下裂手术中使用PDSPlus可显著降低SSI的发生率，术后瘘,和与PDSII相比的再手术率。
