尿道下裂术后尿道分泌物细菌学特点与防治

目的：探讨尿道下裂术后尿道支架管分泌物的细菌学特点,探讨其预防与治疗措施.方法：本组33例,手术方式为原位尿道板代尿道（Snodgrass）12例,带蒂包皮横行内板代尿道（Duckett）17例,Duplay＋Duckett4例,均采用膀胱穿刺造瘘,尿道放置支架管,术后分别于24 h、72 h、5天留取尿道支架管分泌物做细菌培养,根据培养结果选择相应的治疗措施.院外随访3个月～1年.结果：术后24 h,20例细菌培养阳性,其中大肠埃希菌16例（80%）,金黄色葡萄球菌3例,阴沟肠杆菌1例.术后72 h,6例细菌培养阳性,第5天有2例细菌培养阳性（新发阳性绿脓杆菌1例）.尿瘘4例,阴茎根部感染化脓1例,尿道狭窄5例.结论：尿道下裂术后感染的细菌主要是肠道菌,术后采用有针对性的治疗措施是提高术后成功率的有效措施.

The Bacteriological Character of Urethral Secretion and the Preventive and Curative Measures of Hypospadia after Operation

Objective：To explore the bacteriological character of urethral secretion and preventive and curative measures in hypospadia after operation. Methods：There were 33 cases of this group ,all patients underwent surgical treatment with Snodgrass procedures 12 cases, and Duckett procedures 17 cases, and Duplay-Duckett 4 cases. And all patients underwent epicystostomy and were put supporting tube in their urethra. With general nursing before operation, we collected Urethral Secretion for germiculture after 24 h, 72 h and 5 d respectively, and different nursing interventions were used acorrding to bacterial culture. According to culture results, select the appropriate therapeutic measures. Outside the hospital were followed up 3 months to 1 year. Results： Among 33 cases of hypospadias, 20 cases were found gemiculture positive in 24 hours after operation , Escherichia coli 16 cases（80%）, Staphylococcus aureus 3 cases, Enterobacter cloacae 1 cases. On the other hand, there were 6 gemiculture positive cases after 72 hours, and only one case Staphylococcus aureus and one case Pseudomonas aeruginosa positive bacterial culture after operation 5th day. Among all patients, there were 4 cases complicating urinary fistula, 5 cases urethrostenosis,and one infection at the root of the penis. Conclusions：The bacterial infection of hypospadia after operation mainly caused by intestinal bacteria. Nichetargeting treatment and nursing may improve operation success rate of hypospadia.