改良Brisson术治疗重度隐匿性阴茎

Effectiveness of modified Brisson surgery in treatment of severe concealed penis

目的探讨改良Brisson术治疗重度及合并明显肥胖的隐匿性阴茎疗效。方法回顾性分析2014年1月—2016年8月采用改良Brisson术治疗的96例重度隐匿性阴茎患儿临床资料,其中合并明显肥胖53例。患儿年龄1岁～11岁9个月,平均5岁3个月。采用阴茎阴囊正中纵切口替代阴茎阴囊交界处楔形皮肤切口,充分暴露术野;充分松解并切除阴茎周围异常肉膜及筋膜组织;利用原位推进及旋转皮瓣匹配包皮内板,完全去除皮肤狭窄。术后定期随访,采用Boemers标准评价术后疗效。结果术后切口均Ⅰ期愈合,包皮皮瓣无感染、坏死发生。93例患儿获随访,随访时间1年～3年6个月,平均2年4个月。术后48 h内出现2例阴囊血肿、5例阴茎皮肤水肿,1例术后1个月阴茎阴囊角切口瘢痕增生。90例患儿阴茎体显露良好,立位及端坐位均无阴茎体退缩,家属对阴茎外观满意;3例显露一般,端坐位时阴茎部分回缩入耻骨前脂肪,阴茎皮肤附着部分松脱,影响外观。结论采用改良Brisson术治疗重度及合并明显肥胖的隐匿性阴茎,并发症少,效果满意。

Objective To discuss the effectiveness of modified Brisson surgery in treatment of the severe andobviously obese concealed penis. Methods A clinical data of 96 boys with severe concealed penis, of 53 cases combinedwith obviously obese, who were treated by modified Brisson surgery between January 2014 and August 2016, wasretrospectively analysed. The children ranged in age from 1 year to 11 years and 9 months, with an average of 5 years and3 months. The median longitudinal incision of the penis scrotum was used instead of the wedge-shaped skin incision atthe junction of the penis and scrotum, which could completely expose the surgical field; fully release and removal of theabnormal meat membrane and fascia around the penis were performed; the propulsion and rotating flaps match the innersheath of the foreskin was used to completely remove skin stenosis. Postoperative effectiveness was evaluated by Boemersstandard. Results All the incisions healed by first intention and no infection or necrosis of the foreskin flap occurred.Ninety-three cases were discharged from hospital after operation and followed up 1 year to 3 years and 6 months, with anaverage of 2 years and 4 months. Scrotal hematoma occurred in 2 cases within 48 hours, penile skin edema occurred in5 cases, and scar hyperplasia in the penis scrotal corner incision occurred in 1 case at 1 month after operation.Postoperative exposure of the penis was good in 90 cases; there was no retraction of the penis in the upright position andsitting position; the family members were satisfied with the appearance of the penis. The penis were partially retracted in3 cases, that affected the appearance of the penis during the sitting position. Conclusion The modified Brisson surgery isone of the most effective methods to treat the severe and obviously obese concealed penis, with satisfactory effectivenessand less complication.