儿童隐匿阴茎分型诊疗的临床探讨

Classification and treatment of concealed penis in children

目的探讨小儿隐匿阴茎的分型及治疗。方法对我院2009年12月至2013年12月收集的83例小儿隐匿阴茎患儿的临床资料进行回顾性分析，根据包皮口夹角角度对其进行分型，隐匿阴茎I型：包皮口夹角为30°～45°，隐匿阴茎Ⅱ型：包皮口夹角为46°～90°，隐匿阴茎Ⅲ型：包皮口夹角为大于90。，其中，I型隐匿阴茎3例，Ⅱ型10例，Ⅲ型70例。隐匿阴茎Ⅰ型和Ⅱ型采用改良Bris—son术，隐匿阴茎Ⅲ型采用改良Shiraki术，根据Boemers标准评价术后效果，术后总体效果可分为良好、一般和不良。结果术后5～6d去除敷料暴露伤口并拔除尿管，术后6～7d出院。所有病例均获得随访6个月至2年，平均12个月，12例有包皮内板轻度水肿，随访6～12周后均恢复正常；81例阴茎体显露良好，家长对阴茎外观满意，2例阴茎体显露一般。结论通过不同手术方法治疗不同分型的儿童隐匿阴茎，针对性强，阴茎外观良好，并发症相对较少。

Objective To explore the classification and treatment of concealed penis in children. Methods From December 2009 to December 2013, a total of 83 consecutive patients with concealed penis were reviewed and classified by ostium praeputiale angle. The clinical grades of concealed penis were I （30-45 degrees, n = 3）, II （46-90 degrees, n = 10） and III （〉90 degrees, n = 70）. Grades I and II underwent modified Brisson while grade III had modified Shiraki. Based upon the Boemers criteria, the overall postoperative outcomes were good, average and poor. Results Wound dressing and urinary tube were removed at Day 5/6 after operation. All patients were discharged at Day 6/7. During an average follow-up period of 12 （6-24） months, there was no occurrence of voiding problems. Twelve cases with inner prepuce edema recovered within 6-12 weeks. Eventual appearance was satisfactory （n= 81） and minuscule （n = 2）. Conclusions With few complications and satisfactory cosmetics, different grades of pediatric concealed penis may be adequately managed by individualized operations.