改良Devine术治疗儿童隐匿性阴茎的临床疗效研究

Clinical efficacy of modified Devine operation in the treatment of concealed penis in children

目的总结儿童隐匿性阴茎特点和影响因素及改良Devine术治疗儿童隐匿性阴茎的临床疗效。方法回顾性分析我科2013年6月至2017年6月间73例采用改良Devine术治疗隐匿性阴茎患儿的临床资料,随访6个月至2年,并进行统计学分析。结果患儿平均年龄为(9.5±3.2)岁,平均BMI值为(23.9±1.9),平均手术时间(88.8±23.4)min,术前阴茎平均长度(1.83±0.91)cm,术后阴茎平均长度(5.24±0.92)cm,平均直径为(1.76±0.38)cm,平均手术延长外露阴茎为(3.48±1.22)cm,合并阴茎系带短小65例,占89.0%,合并阴囊畸形56例,占76.7%。术后并发淤血5例,阴茎皮肤缺血1例,治疗后均恢复。随访无阴茎回缩或下屈。结论隐匿性阴茎患儿大部分体质量超标,且为腹型肥胖,提示肥胖为隐匿性阴茎主要发病因素之一。隐匿性阴茎患儿常伴有阴茎系带及阴囊发育异常。改良Devine术治疗隐匿性阴茎效果确切,术中采取整形美容缝合并对系带、阴囊同期矫形,与其他术式相比,外观更自然,副损伤更小,是治疗隐匿性阴茎的一种较好的方法。

Objective To analyze the characteristics of concealed penis in children and its influencing factors, and evaluate clinical efficacy of modified Devine operation in the treatment of concealed penis. Methods We retrospectively review clinical data of 73 patients with concealed penis, which had been corrected by modified Devine operation between June 2013 and June 2017. The follow-up period of these patients was from 6 months to 2 years. Data on the patients' age, operative time, postoperative complications and malformation were collected and analyzed. Results The mean age of the children was 9.5±3.2 years, the average BMI was 23.9±1.9. The average operation time was 88.8±23.4 min. The mean perpendicular penile length was 1.83±0.91 cm preoperatively and 5.24±0.92 cm postoperatively, with an improved average length of 1.76±0.38 cm in the flaccid state postoperatively (P<0.001). Sixty-five cases (89.0%) had shot phallic frenulum and 56 cases (76.7%) scrotum malformation. Five patients had penile congestion and one patient had penile skin ischemia postoperatively. However, they all were recovered after treatment. There were no phallocampsis or penis retraction in followup period. Conclusion Most of children with concealed penis were overweight, suggesting that obesity might be one of the main risk factors. Children with concealed penis were frequently accompanied with a deformity of the phallic frenulum and scrotum. Modified Devine operation show better curative effect in the treatment of concealed penis, and fewer complications, achieving marked asthetics, and functional improvement by using aesthetic surgical techniques and straightening the phallic frenulum and scrotum at the same time. It is a relatively ideal means for treatment of concealed penis.