应用中国商环包皮环切手术标准化方案对328例成年男性包皮环切的临床报告  

A Recommendable Standard Protocol of Adult Male Circumcision with the Chinese Shang Ring:Outcomes of 328 Cases in China

作　　者：程跃[1] 彭弋峰[2] 刘毅东[3] 田龙[4] 吕年青[5] 苏新军[1] 严泽军[1] 胡嘉盛[1] Richard LEE Howard KIM David C. SOKAL 李石华[6] 

机构地区：[1]宁波大学医学院附属宁波市第一医院泌尿中心,浙江宁波315010 [2]皖南医学院弋矶山医院性医学科,安徽芜湖241001 [3]上海交通大学医学院附属仁济医院泌尿科,上海200127 [4]首都医科大学附属北京朝阳医院泌尿科,北京100034 [5]江苏省计划生育科学技术研究所,江苏南京210036 [6]Center for Male Reproductive Medicine and Microsurgery,Cornell Institute for Reproductive Medicine,Department of Urology,The New York Presbyterian Hospital,Weill Medical College of Cornell University,New York,NY 10065-4870,USA [7]Family Health International,Research Triangle Park,NC 27709,USA

出　　处：《中华男科学杂志》2009年第7期584-592,共9页National Journal of Andrology

摘　　要：目的:成年男性包皮环切手术标准化和培训可显著降低因手术引起的并发症发生率。由于目前国内外尚无可供参考的成年男性包皮环切手术标准化方案和培训制度,使得临床医生开展成年男性包皮环切手术的质量无法保证。为了建立成年男性包皮环切手术标准化和培训制度,便于临床医生和相关医护人员学习和掌握包皮环切器的临床应用技巧,以中国商环(简称"商环,ShangRing")包皮环切技术为例,根据商环的技术特点和临床实践经验,特别制订了商环包皮环切手术标准化方案,并将其标准化操作运用于临床。方法:采用商环包皮环切手术标准化方案对328例受术者(年龄18～58岁,平均27.8岁;已婚134例,未婚194例;包茎25例,包皮过长303例)进行包皮环切手术。对手术时间、疼痛评分(视觉模拟评分法,VAS)、术后并发症、包皮创口愈合时间、术后外观满意情况进行观察和随访。结果:手术时间为(4.70±1.31)min。手术时受术者疼痛(VAS)评分为(0.24±0.59)分,术后24h疼痛评分为(1.59±0.95)分,去环前24h内疼痛评分(1.72±1.11)分,去环时疼痛评分为(2.72±1.37)分。主要并发症发生率为术后感染0.6%(2/328)、出血0.6%(2/328)、伤口裂开0.6%(2/328)和水肿4.89%(16/328)。在发生出血和伤口裂开的受术者中无1例需要缝合。术后包皮创口完全愈合时间为(20.30±6.69)d。受术者对术后外观满意率99.7%(327/328)。结论:商环包皮环切术具有手术方式易于标准化、手术时间短、术中疼痛轻、术后无须特殊护理、容易完整保留系带,并完全暴露冠状沟、术后外观满意度高、受术者易于接受等优点。初步证明了中国商环包皮环切手术标准化方案的可接受性,严格按照此方案实施手术和随访护理,能最大化地实现商环包皮环切技术的诸多临床优势,将并发症发生率控制在可接受的范围内。Objective ： Standardization of and training in adult male circumcision can significantly reduce its complication rate. Currently no such program exists for its standardization and training, making it difficult to guarantee the quality of male circumcision services. We therefore established a standardized surgical protocol for adult male circumcision in China using the Shang Ring, and applied it to a clinical study examining the performance of the Shang Ring in adult male circumcision. Methods ： A total of 328 adult men aged 18-58 （mean 27.8） years, 25 with phimosis and 303 with redundant prepuce, underwent circumcision with the Shang Ring, and evaluation of the operation time, pain scores （ using the visual analog scale）, postoperative complications, time for wound healing, and their satisfaction with the postoperative appearance. Results ： The operation time was 4.7 ±1.3 minutes. The pain scores were 0.2 ± 0.6 during the surgery, 1.6 ± 1.0 twenty hours postoperatively, 1.7 ± 1.1 twenty hours prior to the ring removal, and 2.7 ± 1.4 during the ring removal. Complications included infection in 2 （0.6%）, bleeding in 2 （0.6%）, and wound dehiscence in 2 （0.6%） of the patients. None of the patients with wound dehiscence required postoperative suturing and all were managed conservatively instead. Sixteen of the patients （4.9%） experienced penile edema. The time for complete wound healing after circumcision was 20.3 ± 6.7 days. The rate of the patients satisfaction was 99.7% （ 327/328 ）. Conclusion ： The standard protocol of adult male circumcision with the Shang Ring has the advantages of short operation time, slight pain, low rate of complications, and high satisfaction and acceptance of the patients. Strict standardization of the surgical protocol can maximize its clinical advantages for adult male circumcision.

关 键 词：包皮环切术 中国商环 标准化方案 并发症 男性 成年人 

分 类 号：R699[医药卫生—泌尿科学]