"纽扣法"带蒂岛状包皮背侧皮瓣转移术在儿童重型隐匿阴茎的应用  

Clinical analysis of surgical approach of severe concealed penis by wrapping dorsal flap transfer with pedicle island in children

作　　者：齐灿[1] 张铁军[1] 褚登伟 高靖达 史丽萍[1] 贾鹏宇 周云[1] 邢民者 刘朋 许鹏 Qi Can;Zhang Tiejun;Chu Dengwei;Gao Jingda;Shi Liping;Jia Pengyu;Zhou Yun;Xing Minzhe;Liu Peng;Xu Peng(Department of Urology,Children’s Hospital of Hebei Province,Shijiazhuang 050031,China;Department of Operating,Children’s Hospital of Hebei Province,Shijiazhuang 050031,China;Division of Medical Insurance,Department of Urology,Children’s Hospital of Hebei Province,Shijiazhuang 050031,China)

机构地区：[1]河北省儿童医院泌尿外科,石家庄050031 [2]河北省儿童医院手术室,石家庄050031 [3]河北省儿童医院泌尿外科医保处,石家庄050031

出　　处：《中华小儿外科杂志》2021年第4期345-349,共5页Chinese Journal of Pediatric Surgery

基　　金：河北省重点研发计划项目-民生科技专项(19277796D);2019年度河北省医学科学研究课题计划(20190793)。

摘　　要：目的探究"纽扣法"带蒂岛状包皮背侧皮瓣转移术在儿童重型隐匿阴茎的临床应用情况。方法收集2016年1月至2019年1月在河北省儿童医院行"纽扣法"带蒂岛状包皮背侧皮瓣转移术治疗的重型隐匿阴茎48例患儿的临床资料。其中,患儿平均年龄为7岁1个月,年龄范围为3~16岁;本研究患儿的纳入标准为重型隐匿阴茎,阴茎完全隐匿于皮下,可见锥状皮丘内无阴茎显露,腹壁皮肤平面仅能扪及包皮套,年龄范围要求为3~16岁,手术方式为"纽扣法"带蒂岛状包皮背侧皮瓣转移术。分析患儿术后出血、感染、阴茎回缩等并发症情况,采用Boemers标准进行术后评价,评估该手术方式在重型隐匿阴茎患儿的应用情况。结果48例患儿均顺利完成手术,术后Boemers标准评价均为良好,家长对阴茎外观满意,术后切口均Ⅰ期愈合,包皮转移皮瓣无坏死感染。术后有8例患儿出现转移皮瓣的明显水肿,6~8周恢复正常。术后随访12个月阴茎体均无回缩,无包皮赘生及瘢痕狭窄,无痛性勃起等其他并发症。结论"纽扣法"带蒂岛状包皮背侧皮瓣转移术是治疗重型隐匿阴茎的理想手术方式,可以有效解决重型隐匿阴茎皮肤覆盖缺损的问题,具有术后外观美观,并发症少等优势,值得临床推广。Objective To explore the clinical application of wrapping dorsal flap transfer with pedicle island for severe concealed penis in children.Methods Clinical data were reviewed for 48 cases of severe concealed penis treated by wrapping dorsal flap transfer with pedicle island("button approach").The average age was 85(36-192)months.The postoperative complications of hemorrhage,infection and penile retraction complications were statistically analyzed.The surgical outcomes were evaluated by the Boemers scheme.Results All operations were successful.The outcomes were decent and all parents were satisfied with penile appearances.All incisions healed with stageⅠand foreskin transfer skin flap survived without infection or necrosis.Eight cases of edematous foreskin normalized within 6-8 weeks.During a follow-up period of 12 months,there was no instance of retracting penile body,swollen foreskin,scar stricture,painless erection or other complications.Conclusions The method of wrapping dorsal flap transfer with pedicle island is ideal for treating severe concealed penis.It can effectively resolve the problem of skin covering defect with satisfactory postoperative appearance and fewer complications.Thus wider popularization is worthwhile.

关 键 词：儿童 隐匿阴茎 皮瓣转移 皮肤缺损 

分 类 号：R726.9[医药卫生—儿科]