应用梯状手术策略治疗儿童先天性隐匿阴茎

Ladder step strategy for surgical repair of congenital concealed penis in children

目的：探讨梯状手术策略治疗儿童先天性隐匿阴茎的可行性。方法：选择2013年11月至2015年11月在我院手术的患儿（年龄18个月至12岁，平均5.7岁）为研究对象，其中轻度9例，中度32例，重度11例。该梯状手术策略包括5个基本步骤：切开狭窄环、脱套阴茎皮肤、固定阴茎根部皮肤、覆盖阴茎体和整形缝合包皮。前瞻性收集患儿资料并进行统计学分析。结果：52例患儿接受了梯状策略的手术治疗。其中20例需修剪并重塑包皮系带；27例增加了阴茎阴囊连接部切口；分别有8例和11例运用了“渐进性阴囊转移皮瓣”和“转移性带蒂包皮皮瓣”；44例重塑了阴茎阴囊角。手术时间40～100min；出血量5～30ml；术后住院3～6d。术后早期1例切口出血，5例切口感染；3～6个月复查，2例阴茎体回缩，2例腹侧包皮冗余，1例阴茎下弯，其余总体阴茎外形美观。结论：应用梯状手术策略治疗儿童先天性隐匿阴茎，操作简单，创伤较小，术后外形美观。

Objective： To assess the feasibility of the ladder step strategy in surgical repair of congenital concealed penis in children. Methods： This study included 52 children with congenital concealed penis treated in the past two years by surgical repair using the ladder step strategy, which consists of five main steps ： cutting the narrow ring of the foreskin, degloving the penile skin, fixing the penile skin at the base, covering the penile shaft, and reshaping the prepuce. The perioperative data of the patients were prospectively collected and statistically described. Results ： Of the 52 patients, 20 needed remodeling of the frenulum and 27 received longitudinal incision in the penoscrotal junction to expose and deglove the penile shaft. The advanced scrotal flap technique was applied in 8 children to cover the penile shaft without tension, the pedicled foreskin flap technique employed in 11 to repair the penile skin defect, and excision of the webbed skin of the ventral penis performed in another 44 to remodel the penoscrotal angle. The operation time, blood loss, and postoperative hospital stay were 40 - 100 minutes, 5 - 30 ml, and 3 , 6 days, respectively. Wound bleeding and infection occurred in 1 and 5 cases, respectively. Follow-up examinations at 3 and 6 months after surgery showed that all the children had a satisfactory penile appearance except for some minor complications （2 cases of penile retraction, 2 cases of redundant ventral skin, and 1 case of iatrogenic penile curvature）. Conclusion： The ladder step strategy for surgical repair of congenital concealed penis in children is a simple procedure with minor injury and satisfactory appearance of the penis. Natl J Androl, 2016, 22 （11） ： 984 -990