探讨糖尿病患者采用包皮环切缝合器手术的可行性。

回顾性研究南京医科大学附属明基医院苏州院区2019年12月至2022年2月收治的行包皮环切术的89例糖尿病患者病历资料。依据切除包皮的手术方式不同，分为包皮环切缝合器手术组(n＝36)、传统包皮环切手术组(n＝53)。患者入院后完善术前常规化验和检查，控制血糖，包皮环切缝合器手术组患者术中选择相应型号的一次性包皮环切缝合器切割、缝合包皮；传统包皮环切手术组患者术中距离冠状沟0.5~1.0 cm处用组织剪剪去多余包皮，电刀严密止血后用可吸收线间断缝合。2组患者均用纱布和弹力绷带加压包扎伤口。术后2组患者均予以口服第2代头孢菌素类抗生素3 d预防感染，术后第1天予以更换纱布和弹力绷带，之后每2 d更换1次，直至伤口愈合拆除纱布和弹力绷带为止。比较2组患者平均手术时间、平均术中出血量、术后并发症以及记录包皮环切缝合器手术组吻合器损伤龟头例数。数据行Mann-Whitney U检验、χ²检验和Fisher确切概率法检验。

包皮环切缝合器手术组患者平均手术时间[10.0(6.3，14.8) min]和平均术中出血量[1.0(1.0，2.0) mL]显著短于及少于传统包皮环切手术组[28.0(23.0，33.0)min、2.0(1.0，5.0) mL]，差异均有统计学意义(Z＝-7.787、-3.884，P<0.05)。术后包皮环切缝合器手术组伤口瘀斑8例(22.2%)，高于传统包皮环切手术组[2例(3.8%)]，差异有统计学意义(χ²＝5.583，P＝0.018)。包皮环切缝合器手术组术后伤口血肿5例(13.9%)、伤口感染5例(13.9%)、伤口全部裂开5例(13.9%)，与传统包皮环切手术组(0、0、0)比，差异均有统计学意义(P＝0.009、0.009、0.009)。包皮环切缝合器手术组术后未出现伤口局部裂开，与传统包皮环切手术组[1例(1.9%)]比较，差异无统计学意义(P＝0.596)。伤口瘀斑较为常见可自行消退；增加弹力绷带层数基础上加压包扎2 d伤口血肿消失；针对伤口感染、伤口全部裂开，予以拆除全部包皮吻合器的钉和硅胶垫片后消毒、包扎，待伤口感染控制后，用可吸收线重新缝合；针对伤口局部裂开应用苯扎氯铵局部消毒。包皮环切缝合器手术组患者术中均未出现吻合器损伤龟头。

术前经过严格筛选和沟通后的糖尿病患者行包皮环切缝合器是安全可行的，而且具有手术便捷和手术体验较好等优点。

To investigate the safety and effectiveness of circumcision suture device in patients with diabetes mellitus.

A retrospective study was conducted on the clinical data of 89 diabetic patients who had undergone circumcision and met the inclusion criteria admitted to Suzhou District of BenQ Medical Center, Affiliated BenQ Hospital of Nanjing Medical University from December 2019 to February 2022. According to the different surgical methods of circumcision, they were divided into the circumcision suture device group (n= 36) and the traditional circumcision group (n=53). After the patients were admitted to the hospital, the routine test and examination before operation were accomplished and the blood glucose was controled. The corresponding type of disposable circumcision suture device was chose to cut and suture the foreskin in the circumcision suture device group. In the traditional circumcision group, the excess prepuce was cut off with tissue scissors at a distance of 0.5-1.0 cm from the coronal sulcus. After hemostasis by electrotome, the patients were sutured intermittently with absorbable thread. Patients in both groups were treated with gauze and elastic bandage. After surgery, patients in both groups received oral second-generation cephalosporin antibiotics for 3 days to prevent infection. Gauze and elastic bandage were replaced on the first day after surgery, and then replaced every 2 days until wound was healed and gauze and elastic bandage were removed. The average operation time, average intraoperative blood loss and postoperative complications were compared between the two groups, and the number of cases of balanus injury caused by stapling device in the circumcision suture device group was recorded. Data were processed with Mann Whitney U test, chi-square test and Fisher′s exact test.

The average operation time [10.0 (6.3, 14.8) min] and intraoperative blood loss [1.0 (1.0, 2.0) mL] in the circumcision suture device group were significantly lower than those in the traditional circumcision group [28.0 (23.0, 33.0) min] and [2.0 (1.0, 5.0) mL], and the differences were statistically significant (Z=-7.787, -3.884; P<0.05). There were 8 cases (22.2%) of wound ecchymosis in the circumcision suture device group after operation, which was higher than that in the traditional circumcision group [2 cases (3.8%)], the difference was statistically significant (χ²=5.583, P=0.018). There were 5 cases (13.9%) of wound hematoma, 5 cases (13.9%) of wound infection and 5 cases (13.9%) of total wound dehiscication in the circumcision suture device group, which were higher than those in the traditional circumcision group (0, 0, 0), the differences were statistically significant (P=0.009, 0.009, 0.009). There was no local wound dehiscication in the circumcision suture group, compared with the traditional circumcision group [1 case (1.9%)], there was no statistically significant difference (P=0.596). Ecchymosis of the wound was more common and would subside spontaneously. Postoperative wound hematoma could disappear after 2 days of compression dressing based on increasing the number of elastic bandage layers. For wound infection and total wound dehiscication, all foreskin staplers and silicone spacers should be removed and then disinfected and bandaged. After wound infection was controlled, absorbable thread was used for resuture. Partial wound dehiscication was needed local disinfection with benzalkonium chloramine. None of the patients in the circumcision suture group had balanus injury caused by stapling device during operation.

It is safe and feasible for patients with diabetes mellitus to receive the circumcision suture device after strict screening and communication before operation, and it has the advantages of convenient operation and good surgical experience.