竖形带蒂皮瓣横置法治疗重度小儿隐匿阴茎的应用研究

Traversing the vertical pedicle flap for the treatment of severely buried penis in children

目的:探讨竖形带蒂皮瓣横置法治疗重度小儿隐匿阴茎的疗效。方法:收集我院2014年2~12月手术治疗的隐匿阴茎患儿43例,随机分两组,试验组21例采用竖形带蒂皮瓣横置法,对照组22例采用改良Shiraki术式。比较两组的手术时间、术中出血量、包皮消肿时间及家长对外观满意度。结果:试验组与对照组手术时间分别为(45.0±6.8)min和(42.0±5.3)min,术中出血量为(5.0±1.2)ml和(6.0±0.8)ml,均无统计学差异(P>0.05);阴茎消肿时间为(9.0±2.3)d和(15.0±4.8)d,家长满意度为95.23%和31.81%,两组之间有统计学差异(P<0.05)。两组患儿均在术后3 d拆除阴茎敷料及弹力绷带,术后的随访观察3~6个月,所有病例阴茎体显露良好,无回缩及复发,但是试验组包皮消肿时间短,外型更美观,家长更满意。结论:竖形带蒂皮瓣横置法治疗重度小儿隐匿阴茎,能够更加合理利用包皮,彻底解除包皮狭窄环且外形美观,对于治疗重度小儿隐匿阴茎,是一种可行的手术方式。

Objective： To assess the effect of traversing the vertical pedicle flap （TVPF） for the treatment of severely buried penis in children. Methods ： Totally 43 children with severely buried penis underwentTVPF （ n = 21 ） or modifiedShiraki surgery （control, n = 22） in our hospitalfrom February to December 2014. Wecompared the operation time, intra-operation blood loss, fore- skin swelling time, and parents＂ satisfaction with penile appearance between the two groups. Results： No statistically significant differences were observed between the TVPFand control groups in the operation time （ [ 45.0 ±6.8 ] vs [ 42.0±5.3 ] min, P 〉 0.05 ） or intra-operation blood loss （ [ 5.0 ± 1.2 ] vs [ 6.0 ± 0.8 ] ml, P 〉 0. 05 ）. The average foreskin swelling time was markedly shorter in the TVPFgroup than in the control （ [ 9.0 ± 2.3 ] vs [ 15.0 ±4.8 ] d, P 〈 0.05 ） and the parents＇satisfaction with penile ap- pearancewas higher in the former than in the latter （95.23vs31.81% , P 〈 0.05）. The elastic bandages were removedfor all the pa- tientsat 3 days postoperatively, and 3 to 6-month follow-up revealed no penile retraction or relapse. Conclusion ： The method of trav- ersing the vertical pedicle flap is a feasible surgical option for the treatment of severely buried penis in children, which can make a ra- tional use of the foreskin, remove the tight ring, and achieve a satisfactory appearance of the penis.