基于阴茎发育规律的儿童包皮环切术式探讨

Prospective analysis of selecting penile diameter,circumcision stapler and foreskin cerclage in children

目的根据儿童阴茎发育规律,探讨两种包皮环切术式与阴茎直径(d)选择的关系。方法收集本院包皮过长或包茎患儿共358例,其中包茎171例,包皮过长187例,患儿年龄4～16岁,年龄中位数(9.0±2.2)岁;阴茎直径1.2～3.0 cm,中位数(1.5±0.4)cm。按照家属自愿随机原则分组,A组应用一次性缝合器行包皮环切术,共191例;B组行包皮环扎术,共167例。分析阴茎直径发育趋势及两种术式术后并发症与阴茎直径之间的关系,比较两种术式手术时间、术中出血量和治疗费用以及术后30 d随访情况。结果 (1)儿童年龄与阴茎直径呈正相关性(r=0.4,P<0.05)。(2)A组与B组术后总并发症的发生率分别是5.24%(10/191)和2.40%(4/167),差异无统计学意义(P=0.18);在1.2 cm≤d<1.5 cm段,A组术后包皮粘连的发生率83.33%(10/12),B组无一例并发症,差异有显著统计学意义(P<0.0001)。在1.5 cm≤d<2.6 cm段,两组均无并发症。在d≥2.6 cm段,A组无一例并发症,B组并发症的发生率为25%(4/16),差异有统计学意义(P=0.03)。(3)A组和B组平均治疗费用分别为(2 105.81±47.37)元和(526.63±24.58)元,差异有统计学意义(P<0.0001)。(4)术后30 d随访,A组一次性缝合钉未脱并包皮内板分粘率3.66%(7/191);在1.2 cm≤d<1.5 cm段,B组包皮结扎环未脱率7.19%(12/167),在d≥2.6 cm段,两组差异无明显统计学意义(P=0.16)。结论儿童包皮环扎术和一次性缝合器包皮环切术有阴茎直径选择性,包皮环扎术适用于d<1.5 cm的包茎、包皮过长儿童或幼儿;一次性缝合器包皮环切术适用于d≥2.6 cm的包茎、包皮过长大龄儿童或青少年;在1.5 cm≤d<2.6 cm段,两种方法均可。

Objective To select penile diameter（ d） according to the clinical efficacies of circumcision stapler and foreskin cerclage in children. Methods A total of 358 children with phimosis or redundant prepuce were treated with circumcision stapler（ group A） and foreskin cerclage（ group B）. The median age was9. 0 ± 2. 2（ 4 ～ 16） years and the median penile diameter 1. 5 ± 0. 4（ 1. 2 ～ 3. 0） cm. The development trend of penile diameter was analyzed. And two groups were compared in terms of incidence and relationship of postoperative complications and/or penile diameter,operative duration,intraoperative blood loss,cost of treatment and30-day follow-ups. Results Age was positively correlated with penile diameter（ r = 0. 4,P〈0. 05）. The incidences of postoperative complications of groups A and B were 5. 24%（ 10/191） and 2. 4%（ 4/167）. There were no significant statistical differences（ P = 0. 18）. For 1. 2 cm ≤d 1. 5 cm,the perpetual adhesion of postoperative complications were 83. 33%（ 10/12） in group A and 0%（ 0/25） in group B. There were significant statistical differences（ P〈0. 0001）; For 1. 5 cm ≤d 2. 6 cm,no postoperative complications occurred; For d≥2. 6 cm,the postoperative complications was 0%（ 0/20） in group A versus 25%（ 4/16） in group B. There were significant statistical differences（ P = 0. 03）. The average treatment costs for groups A and B were（ 2105.81 ± 47. 37） and（ 526. 63 ± 24. 58） RMB respectively. There were statistical significant differences（ P〈0. 0001）. During 30-day follow-ups,3. 66%（ 7/191） required broken nail and stick in group A. For 1. 2 cm ≤d 〈1. 5 cm,7. 19%（ 12/167） in group B; For d〉 2. 6 cm,there were no significant statistical differences（ P =0. 16）. Conclusion Circumcision stapler and foreskin cerclage have a diameter of penile selectivity in children. Foreskin cerclage is applicable for d 〈1. 5 cm. However,circumcision stapler is suitable for d≥2. 6 cm.