改良Brisson术联合皮瓣裁剪技术治疗儿童重度隐匿阴茎  

Modified Brisson surgery combined with skin flap clipping for the treatment of severe concealed penis in children

作　　者：肖智祥[1] 徐迪[1] 何少华 XIAO Zhi-xiang;XU Di;HE Shao-hua(Department of Pediatric Surgery,Fujian Provincial Hospital/Provincial School of Clinical Medicine,Fujian Medical University,Fuzhou,Fujian 350001,China)

机构地区：[1]福建医科大学省立临床医学院/福建省立医院小儿外科,福建福州350001

出　　处：《中华男科学杂志》2020年第9期820-825,共6页National Journal of Andrology

摘　　要：目的:探讨改良Brisson术联合皮瓣裁剪技术治疗儿童重度隐匿阴茎的效果。方法:回顾性分析2014年1月至2019年1月由本院小儿外科收治的165例重度隐匿阴茎患儿,其中将采用改良Brisson术联合皮瓣裁剪技术105例分为改良Brisson术组,余60例分为改良Devine术组,所有手术均由同一位医师完成。比较两组病例的手术时间、术中出血量、术后阴茎显露增加值、术后包皮水肿时间、皮瓣坏死率、阴茎回缩率、手术满意度。结果:165例患儿均无阴茎背神经或尿道的损伤,术后无包皮顽固水肿、无痛性勃起。改良Brisson术组平均手术时间(48.3±4.1)min、术中平均出血量(8.4±1.60)ml、术后阴茎平均显露增加值(2.7±0.29)cm、术后包皮水肿时间(3.3±0.93)d、皮瓣坏死1例、6个月随访时阴茎回缩1例。改良Devine术组平均手术时间(48.1±5.0)min、术中平均出血量(12.6±2.10)ml、术后阴茎平均显露增加值(2.3±0.22)cm、术后包皮水肿时间(3.2±0.90)d、局部皮瓣坏死后瘢痕愈合4例、6个月随访时阴茎回缩1例。改良Brisson术组术后随访获得99例,6例失访,家长对手术表示满意95例,5例表示不满意,满意率94.9%,改良Devine术组术后随访获得58例,2例失访,家长对手术表示满意49例,9例表示不满意,满意率84.5%。改良Brisson术组与改良Devine术组在术中平均出血量、术后阴茎平均显露增加值、皮瓣坏死率、手术满意度比较,差异具有统计学意义(P<0.05);而在手术时间、术后包皮水肿时间、6个月随访阴茎回缩率相比较,两组差异无统计学意义(P>0.05)。结论:在儿童重度隐匿阴茎中,采用改良Brisson术联合皮瓣裁剪技术可取得临床满意的疗效,值得推广。Objective:To explore the effect of modified Brisson surgery combined with the skin flap clipping technique in the treatment of severe concealed penis in children.Methods:We retrospectively analyzed the clinical data on 165 children with severely concealed penis treated in our hospital from January 2014 to January 2019,105 by modified Brisson surgery combined with the skin flap clipping technique and the other 60 by modified Devine surgery,all the operations performed by the same surgeon.We compared the two surgical strategies concerning operation time,intraoperative blood loss,postoperative increase of penile exposure,preputial edema duration,flap necrosis and penile retraction,and satisfaction of the patients’parents with the overall surgical effect.Results:No injury of the dorsal nerve or urethra,nor postoperative refractory prepuce edema or painful erection was found in any of the cases.The patients treated by modified Brisson surgery,in comparison with those treated by modified Devine surgery,showed significantly less intraoperative blood loss([8.4±1.60]vs[12.6±2.10]ml,P<0.05),more postoperative increase of penile exposure([2.7±0.29]vs[2.3±0.22]cm,P<0.05),fewer cases of flap necrosis(1 vs 4,P<0.05)and higher rate of satisfaction with the overall surgical effect(94.9%vs 84.5%,P<0.05),but there were no statistically significant differences between the former and the latter groups in the operation time([48.3±4.1]vs[48.1±5.0]min,P>0.05)or the postoperative duration of prepuce edema([3.3±0.93]vs[3.2±0.90]d,P>0.05)or number of cases of penile retraction at 6 months(1 vs 1,P>0.05).Conclusion:Modified Brisson surgery combined with the skin flap clipping technique can achieve satisfactory results in the treatment of severe concealed penis in children and therefore deserves to be popularized in clinical application.

关 键 词：儿童 隐匿阴茎 改良Brisson术 改良DEVINE术 皮瓣裁剪 

分 类 号：R726[医药卫生—儿科] R971.1[医药卫生—临床医学]