先天性单纯阴茎下弯的手术矫治

Management of congenital penile curvature in children

目的 探讨先天性单纯阴茎下弯的手术方法选择.方法 回顾性分析2007年4月至2015年1月收治的109例先天性单纯阴茎下弯患儿的临床资料,年龄1岁1个月～13岁6个月,中位年龄5岁4个月.阴茎下弯根据术中皮肤彻底脱套后情况分为4型：皮肤型（Ⅰ型）50例（45.9％）,筋膜型（Ⅱ型）29例（26.6％）,海绵体型（Ⅲ型）24例（22.0％）,短尿道型（Ⅳ型）6例（5.5％）.Ⅰ型予皮肤彻底脱套后行勃起试验显示阴茎可伸直;Ⅱ型在皮肤脱套的基础上进一步去除Buck＇s筋膜外异常肉膜,勃起试验显示阴茎可伸直;Ⅲ型去除皮肤、筋膜对下弯的影响后,行勃起试验仍显示阴茎下弯,行背侧中线白膜折叠术纠正;Ⅰ、Ⅱ、Ⅲ型中脱套后显露完整膜状尿道的患儿行尿道分叉海绵体对合修复,并采用包皮肉膜覆盖加固膜状尿道;若无法分离皮肤和膜状尿道,则行尿道板纵切卷管尿道成形术.Ⅳ型予离断尿道,去除阴茎腹侧组织对阴茎下弯的影响,解除短尿道对阴茎下弯的影响,横裁包皮内板代替尿道,对于去除短尿道因素后仍有弯曲者予中线背侧阴茎白膜折叠术（＜30.）或腹侧白膜切开睾丸鞘膜补片（≥30.）纠正阴茎下弯.结果 本组109例患儿均获得满意的外观：尿道开口于阴茎头;包皮分布均匀;勃起后阴茎无下弯.37例尿道发育不良患儿术后均未出现尿道裂开、尿道狭窄,其中4例出现漏尿,术后6个月予尿瘘修补术治愈;1例横裁包皮内板代尿道术后出现尿道憩室,予憩室切除及尿道重建后治愈.26例行中线背侧阴茎白膜折叠术者,术后近期（1年）随访,1例残留阴茎下弯;中远期（1～9年,平均3.2年）随访,4例残留阴茎下弯,中远期治愈率为84.6％.结论 先天性单纯阴茎下弯需根据引起弯曲的不同病理类型采用相应的方法来进行矫正,应重视中远期的随访效果.

Objective The aim of this study is to assess the surgical approaches for congenital penile curvature retrospectively.Methods From April 2007 to January 2015,109 patients with congenital penile curvature,age from 13 months to 13 years,mean 64 months,were treated in the Department of Pediatric Urology Surgery,Children＇s Hospital of ZheJiang University,China.According to structural defect,the patients were categorized into 4 groups：group Ⅰ,skin tethering （50 cases,45.9%）;group Ⅱ,fascialchordee （29 cases,26.6%）;group Ⅲi,corporal disproportion （24 cases,22.0%）;and group Ⅳ,urethral tethering （6 cases,5.5%）.With the aid of intraoperative artificial erection,the curvanture was corrected by penile degloving in group Ⅰ patients;group Ⅱ,release of dense fibrous tissue in addition;group Ⅲ,dorsal-midline-plication-based correction;and group Ⅳ,urethral transection and longitudinal-island-flap-urethroplasty-based with dorsal-midline-plication and Tunica-vaginalis-free-graft repair.Results Of the 37 hypoplastic urethra cases,urethral fistula was present in 4 patients,and six months later,urethral repair was successfully performed;and one case undergoing Duckket＇s showed urethral diverticulum,and was corrected by diverticulum resection and urethra mobilization;there was no glans dehiscence and urethral stricture.Of the 26 cases with dorsal-midline-plication-based correction,residual curvature occurred in 1 child after one year;and 4 cases recurred during long-term follow-up （ranging from 1 to 9 years,mean 3.2）,with a 84.6% cure rate.Conclusions Conclusions Those corresponding methods of penile curvature should be choosed based on different pathological type respectively.The findings are limited because this study was retrospective and lacked long-term follow-up data.