包皮过长的手术方式、经验和相关文献复习

Comparison of clinical efficacy of disposable circumcision suture device,conventional and sleeve circumcision

目的总结一次性包皮环切缝合器、经典式及袖套式包皮环切术的经验,比较三种包皮环切术式的各自特点。方法回顾性分析于2014年7月至2016年7月期间在我院行包皮环切术(应用一次性包皮环切缝合器、经典式及袖套式包皮环切术分别为112例、123例及108例)患者的临床资料,比较三种术式手术时间、术中出血量、疼痛评分、术后并发症发生率、阴茎外观满意率等指标。分析三种手术各自特点和经验总结。结果应用一次性包皮环切缝合器、经典式及袖套式包皮环切术手术时间分别为5.6±3.5 min、25.6±6.7 min及34.3±5.4 min(P<0.001),术中出血量分别为2.0±0.7 m L、12.3±5.8 m及4.1±2.3 m L(P<0.001),术后24 h疼痛评分分别为3.1±1.1分、5.4±1.2分及3.5±0.9分(P<0.001),术后并发症发生率分别为9.8%(11/112)、16.3%(20/123)及11.1%(12/108)(P=0.286),术后阴茎外观满意度分别为97.3%(109/112)、85.4%(105/123)及95.4%(103/108)(P=0.001)。以上数据比较,差异均有统计学意义。结论三组手术方式各有优缺点,应用一次性包皮环切缝合器操作简单、手术时间短、术中出血量少、术后阴茎外观满意率高,但费用偏高;而袖套式包皮环切术相对于经典式包皮环切术手术时间稍长,但术中出血量明显减少、术后疼痛评分低且阴茎外观满意度较高,因此,对于青春期男性及成人患者可考虑推荐袖套式包皮环切术。

Objective To summarize the experience of disposable circumcision suture device,conventional and sleeve circumcision and literature review.Methods Clinical data of patients receiving circumcision in our hospital(112patients with disposable circumcision suture device,123with conventional circumcision and108with sleeve circumcision)between July2014and July2016was analyzed retrospectively.The operation time,blood loss,pain score,postoperative complication rate and postoperative penile appearance satisfaction rate were compared among these methods.Results The operation time for disposable circumcision suture device,conventional and sleeve was5.6±3.5min,25.6±6.7min and34.3±5.4min(P<0.001);blood loss for these methods was2.0±0.7m,12.3±5.8ml and4.1±2.3mL(P<0.001).The pain score24hours postoperatively was3.1±1.1,5.4±1.2and3.5±0.9(P<0.001).The postoperative rate was9.8%(11/112),16.3%(20/123)and11.1%(12/108)(P=0.286),and postoperative penile appearance satisfaction rate was97.3%(109/112)、85.4%(105/123)and95.4%(103/108)(P=0.001).Conclusion All the surgical procedures have its own advantage and disadvantage.The disposable circumcision suture device is simple with short operation time,few blood loss and high postoperative penile appearance satisfaction rate,while the cost is high.The sleeve circumcision has longer operation time compared with conventional circumcision,with fewer blood loss,lower pain score and postoperative complication rate,higher penile appearance satisfaction.Therefore,sleeve circumcision could be considered in older boys and adults as recommendation.