改良Devine术和改良Shiraki术治疗完全型隐匿阴茎的对比研究

Clinical efficacy of modified Devine's versus modified Shiraki's procedure for completely concealed penis

目的比较改良Devine术和改良Shiraki术对小儿完全型隐匿阴茎的治疗效果。方法回顾性收集2012年6月年至2016年6月由郑州大学第一附属医院收治的112例隐匿阴茎患儿作为研究对象,依据随机数字表法分为改良Devine术组(n=56)和改良Shiraki术组(n=56),所有手术均由同一名医生完成。比较两组患儿的术中出血量、术后阴茎外露延长值、术后阴茎水肿吸收时间。结果112例患儿切口愈合良好,无阴茎背侧神经、血管和腹侧尿道损伤,无皮瓣坏死及感染,术后无顽固水肿及阴茎勃起痛。改良Devine术组术中平均出血量(8. 2±1. 71) mL,改良Shiraki术组术中平均出血量(16. 3±3. 13) mL,差异有统计学意义(t=12. 01,P <0. 05)。改良Devine术组阴茎体外露延长值平均为(2. 4±0. 48) cm,改良Shiraki术组阴茎体外露延长值平均为(2. 4±0. 56) cm,差异无统计学意义(t=0. 22,P> 0. 05)。改良Devine术组阴茎水肿消退时间明显长于改良Shiraki术组,差异有统计学意义(t=8. 43,P <0. 05)。改良Devine术后阴茎包皮均有水肿,1～3个月后自行吸收。改良Shiraki术后阴茎包皮均有轻度水肿,2周至1个月后自行吸收。改良Devine术后均随访2年,52例阴茎显露满意,4例因固定阴茎根部皮肤的缝合线脱开而复发,经二次手术后效果满意。改良Shiraki术后随访,静息时阴茎体全部外露,包皮口无狭窄,阴茎头部分外露,外观满意,矫形良好。结论完全型隐匿阴茎的手术治疗效果是明确的,应根据不同的临床表现选择合适的手术方式。

Objective To compare the efficacy of modified Devine's versus modified Shiraki's procedure for completely concealed penis in children. Methods From June 2012 to June 2016,clinical data were reviewed for a total of 112 cases of concealed penis.Devine's and Shiraki's procedures were performed (n=56 each).Two groups were compared with regards to volume of intraoperative blood loss,postoperative lengthening value of exposed penis and postoperative penile edema absorption time. Results All incisions healed well without injury of dorsal nerve,blood vessel or ventral urethra injury.There was no skin flap necrosis or infection,stubborn postoperative edema or penile erectile pain.The mean volume of intraoperative blood loss was 8.2±1.71 Ml in Devine's group versus 16.3±3.13 Ml in modified group.And the difference was statistically significant (t=12.01,P<0.05).The average length of exposed penis was 2.4±0.48 cm in Devine's group versus 2.4±0.56 cm in Shiraki's group.And the difference was not statistically significant (t=0.22, P>0.05 ).The regression time of penile edema was significantly longer in Devine's group than that in Shiraki's group.And the difference was statistically significant (t=8.43,P<0.05).After modified Devine's procedure,penile prepuce was edematous and self-absorption subsided after 1-3 months.After modified Shiraki's procedure,penile prepuce was mildly edematous and self-absorption subsided after 2 weeks to 1 month.The follow-up period was 2 years after modified Devine's procedure.Fifty-two cases had satisfactory penile exposure and another four achieved satisfactory outcomes after re-operation due to a breakage of suture line on penile root.After modified Shiraki's procedure.all penile bodies were exposed at rest,foreskin mouth was not narrowed,penis head was partially exposed,appearance was satisfactory and orthopedic was excellent. Conclusion Surgical treatment of concealed penis is definitely efficacious so that appropriate surgical approaches should be selected for different causes.