环T切口3点固定法隐匿性阴茎成形术

Penoplasty with T-shaped incision and three-point fixation for concealed penis

目的:尝试环T切口3点固定法隐匿性阴茎成形术,并与改良Devine术式作对比研究。方法:回顾性分析2014年6月至2016年6月169例隐匿性阴茎手术患者的临床资料,其中采用改良Devine术式59例,环T切口3点固定法110例,对比两组的手术时间、术后并发症及复发率。结果:所有患者均顺利一期完成手术,术后留置导尿3 d,弹力绷带包扎2~4周,术后分别获4~12个月随访,阴茎显露总体满意。手术时间:环T切口组(52.8±6.9)min,改良Devine组(61.5±10.6)min(P<0.001);术后并发症:环T切口组与改良Devine组的比例分别是:包皮水肿17.3%(19/110)vs 33.8%(20/59),皮肤坏死0.9%(1/110)vs 5.1%(3/59),皮肤感染0.9%(1/110)vs 5.1%(3/59),术后出血0.9%(1/110)vs 3.4%(2/59)。环T切口组术后并发症明显少于改良Devine组。术后复发率:环T切口组1/110,改良Devine组4/59(P=0.032)。结论:环T切口3点固定法隐匿性阴茎成形术具有手术创伤小、术中显露良好、阴茎固定可靠、术后并发症少、复发率低、疗效满意等优点,有临床推广价值。

Objective： To search for a safe and effective method of penoplasty with low incidence of complications for con- cealed penis by evaluating penoplasty with T-shaped incision and three-point fixation in comparison with modified Devine＇s technique. Methods： We retrospectively analyzed 169 cases of concealed penis treated in our center by penoplasty with T-shaped incision and three-point fixation （group A, n = 110） or modified Devine＇s surgery （group B, n=59）. We compared the operation time, postop- erative complications, and recurrence rate between the two groups of patients. Results ： Operations were successfully completed in all the cases, the urinary catheters removed at 3 days and the elastic bandages applied for 2 to 4 weeks. The patients were followed up for 4 to 12 months. The penis was satisfactorily exposed. The operative time was significantly shorter in group A than in B （ [52.8 ± 6.9] vs [61.5±10.6] rain, P 〈 0. 001）, the postoperative complication rate was obviously lower in the former than in the latter （prepuceedema： 17.27% [19/110] vs 33.89% [20/59], P = 0.021; bleeding： 0.90% [1/110] vs 3.38% [2/59], P = 0.552; skin necrosis： 0.90% [1/110] vs 5.08% [3/591, P = 0. 123; skin infection： 0.90% [1/110] vs 5.08% [3/59], P = 0.123）, and so was the recurrence rate （0.90% [1/110] vs 6.77% [4/59], P = 0.032）. Conclusion： Penoplasty with T- shaped ineision and three-point fixation deserves to be popularized clinically for its advantages of minor invasion, clear exposure, relia- ble penile fixation, low incidence of postoperative complications and recurrence, and satisfactory outcomes.