小儿阴茎畸形的鉴别诊断和治疗方法

Differential Diagnosis and Management of Penis Abnormalities in Children

目的探讨小儿阴茎畸形的鉴别诊断及治疗方法。方法总结分析遵义医学院附属医院小儿外科近2a收治的阴茎畸形患儿143例的病例资料。其中埋藏阴茎48例(33.57%),隐匿阴茎35例(24.48%),尿道下裂25例(17.48%),蹼状阴茎13例(9.09%),阴茎下弯10例(6.99%),阴茎扭转7例(64.90%),小阴茎5例(3.50%)。结果埋藏阴茎48例中41例一期住院手术,术后随访0.5～1.0a,阴茎外观形态满意38例(92.68%),1例出现包皮口疤痕狭窄,2例阴茎仍轻度埋藏;7例院外误诊为包茎或包皮过长,已行包皮环切术,二期住院手术,阴茎外观形态明显改善。35例隐匿阴茎29例一期就诊,6例院外误诊为包茎或包皮过长,并误行包皮环切术,病例门诊随访均行非手术治疗。25例尿道下裂中18例一期住院手术,治愈15例(83.33%),4例院外手术住院仅行尿瘘修补术,2例会阴型尿道下裂院外误诊为女童,1例单纯阴茎下弯院外手术2次,就诊时阴茎体腹侧中部排尿,均住院行尿道成形术。5例小阴茎行保守治疗,其余阴茎畸形均做阴茎整形术,术后效果满意。结论阴茎畸形的正确诊断、治疗方法的正确选择,防止非专科医师误诊误切包皮,可提高阴茎畸形的治疗效果。

Objective To explore the differential diagnosis and management of penis abnormalities in children.Methods The records of penis abnormalities between Feb.2006 to Dec.2007 were analyzed retrospectively.Of all 143 cases,48 cases（33.57%） with buried penis,35 cases（24.48%）with concealed penis,25 cases（17.48%）with hypospadias,13 cases（9.09%）with webbed penis,10 cases（6.99%）with chordee of penis,7 cases（4.90%）with distortion of penis and 5 cases（3.50%）with microcaulia.Results Forty-one cases with buried penis were operated in the first-stage in hospital.During following up 0.5 to 1.0 year,the cosmetic appearance of penis were very satisfaction in 38 cases（92.68%）,slight buried penis in 2 cases and cicatricial constriction of ostium praeputiale in 1 case.Another 7 cases were operated in the second-stage in hospital and the shape of penis were improved after operation.All concealed penis and 5 cases microcaulia were non-operation treatment.Eighteen cases of hypospadias were operated in the first-stage in hospital and 15 cases（83.33%） were cured in leaving hospital,4 cases urinary fistula-neoplasty.Two cases perineal hypospadias of misdiagnosis girl had been done urethroplasty in the first-stage.Another 1 case pure chordee of penis underwent 2 times operation in other hospital and urine discharged from middle-part of the penile shaft venter and urethroplasty had been performed.The other penis abnormalities were performed penile neoplasty and the shape of penis were very satisfaction in all cases.Conclusion It is very helpful for final choice of treatment methods to make correctly diagnosis of penis abnormalities,prevent misdiagnosis and mistreatment for not specialist and may improve markedly treatment effect.