改良阴茎成形术治疗重度隐匿阴茎(附42例报告)

Use of modified phalloplasty in treating severe concealed penis(report of 42 cases)

目的介绍使用改良Shiraki术联合“V”形切口治疗42例重度隐匿阴茎的方法和效果。方法自2011年8月至2013年8月间本院对42例重度隐匿阴茎患儿采取改良Shiraki联合“V”形切口术，此改良阴茎成形术分3个主要步骤：首先分别在外板的12点处及包皮内板的3点、9点处纵向切开，阴茎皮肤脱套至阴茎根部，同时切除阴茎体外层纤维索带，充分松解阴茎体使其完全伸展；修剪重建包皮系带伸直阴茎头，修剪过宽包皮内板皮瓣，外板尽量保留，然后内外板皮瓣嵌插缝合；最后取阴茎腹侧V形切口，阴茎腹侧延长，重建阴茎阴囊角。结果手术时间约40-55min，随访12-24个月，40例阴茎发育及外观效果满意，2例较肥胖的患者术后阴茎体显露效果不佳。13例包皮内板水肿患者术后12周内均基本消退。结论该术式操作相对简单，损伤小，外观良好，并发症少，我们认为是治疗重度隐匿阴茎比较理想的手术方式之一。

Objetive To determine the effectiveness of modified Shiraki method associated with V- shaped incision as a new surgical treatment method for severe concealed penis. Methods From August 2011 to August 2013,42 patients with severe concealed penis underwent the modified Shiraki method associated with V-shaped incision. The technique consists of 3 steps： 1 ）First is Longitudinal cutting at 3＇, 9＇of inner prepuce and 12＇of outer prepuce, the seperation of inner and outer prepuce, skin degloving, resection of fibrous tissue and mobilization of divergent corpus spongiosum;2） transection and longitudinal suture at the frenulum to elon- gate inner ventral prepuce, excise redundant inner prepuce flap, while outer prepuce is preserve as much as possible,with embedding sutures of irmer and outer prepuce;3 ）At last, through V-shaped incision for the ventral side of the penis, penile ventral extension, reconstruction of penis and scrotum angle. Results The operative time ranged from 40 min to 55 min. The follow-up period was for between 12 - 24 months. The appearance of penis was satisfactory in 40 patients. 2 patient had sub-optimal result because of underlying obesity. 13 cases with inner prepuce edema had good reeovery within 12 weeks after operations. Conclusions Modified Shiraki method associated with V-shaped incision has the advantages of less complication, simple operation and satisfactory appearance. It should be recommended as an ideal operation to treat severe concealed penis.