“双针法”在小儿隐匿性阴茎矫正手术的应用

A Double-Stitch Procedure for the Correction of Pediatric Concealed Penis

目的探讨一种免脱套“双针法”手术治疗小儿隐匿性阴茎的疗效。方法选择2017年1月至2019年1月我院收治的56例隐匿性阴茎患儿,年龄(3.1~10.7)岁,平均(4.71±1.01)岁,均行免脱套的“双针法”的手术方式:阴茎根部腹侧楔形切口,部分游离阴茎体根部后,将阴茎背侧皮下组织与耻骨悬韧带近阴茎Buck筋膜处在12点钟位置固定第1针,腹侧修剪后的皮下组织与阴茎尿道Buck筋膜在6点钟位置固定第2针;重建阴茎耻骨角及阴茎阴囊角,再行多余包皮的内外板切除,留置尿管,弹力绷带加压包扎。记录手术时间、手术前后阴茎长度、术后并发症情况和家长满意度来评估手术效果。结果所有患儿均顺利完成手术,手术时间27~49 min,平均(31.56±1.09)min;术后阴茎长度平均(5.34±0.67)cm,较术前(2.55±0.41)cm明显改善,差异有统计学意义(t=42.62,P<0.001)。术后平均随访(16.21±7.76)个月,患儿术后皮肤水肿轻微,多在2~4周内消退;切口愈合良好,阴茎外观满意,未出现阴茎回缩、扭转、伤口感染等相关并发症;患儿家长对术后阴茎长度、症状改善、外观及总体满意度分别为100%(56/56),98.2%(5/56),94.6%(53/56)和91.1%(51/56)。结论“双针法”手术治疗隐匿性阴茎不需进行阴茎脱套,具有操作简单,创伤小,美容效果良好,并发症率低,父母满意度高的优点,是隐匿性阴茎的可选手术方法之一。

Objective To explore the application effect of a double-stitch for the correction of concealed penis in children.Methods From January 2017 to January 2019,a total of 56 boys with concealed penis,aged from 3.1 to 10.7 years old,were treated by a new degloving-free and double-stitch surgical technique.The wedge incision was located on the ventral of the root of the penis.Putting the subcutaneous tissue of the back of penis with the prepubic suspension ligament near the penis Buck's fascia at 12 o'clock direction was fixed as the first stitch after part dissection of the free penis root.The subcutaneous tissue after ventral trimming with penis urethra Buck's fascia was fixed at 6 o'clock direction as the second stitch;The pubopenis angle and penoscrotum angle was reconstructed.The operation time,penis length,postoperative complications and the satisfaction from parents were recorded.Results All children completed the operation successfully during(31.56±1.09)minutes averagely(ranged from 27 to 49 minute).The length of penis was improved from(2.55±0.41)cm of preoperation to(5.34±0.67)cm of postoperation,and the difference was statistically significant(t=42.62,P<0.001).All cases were followed up for(16.21±7.76)months averagely.The postoperative skin edema was mild,and subsided within 2 to 4 weeks.The incision healed well and the appearance of penis was good without penis retraction,torsion,incision infection and other related complications.The satisfaction rate of the parents was 100%(56/56),98.2%(5/56),94.6%(53/56)and 91.1%(51/56)on penile length,symptom improvement,appearance and overall satisfaction,respectively.Conclusion The surgical method of double-stitch without degloving is a simple,mini-trauma and effective procedure with advantages of good cosmetic effect,low complication rate and high parents'satisfaction rate,and it would be a surgical options for concealed penis.