浅谈改良单人操作行小儿包皮环切术的经验总结

Experience of modified single-person operation for pediatric circumcision

目的总结改良单人操作法应用一次性包皮环切缝合器(DCSD)施行小儿包皮环切术的临床经验、手术技巧、临床效果及术后并发症。方法回顾性分析2018年5月至2020年8月恩施土家族苗族自治州民族医院门诊收治的205例行包皮环切术患儿,随机分为观察组(改良单人手术,102例),对照组(双人手术,103例)。观察两组手术时间、术中出血量、创口水肿时间、术后疼痛评分、钛钉完全脱落时间、完全愈合时间、术后美观满意度及术后并发症(如系带损伤、感染、1个月后包皮再次粘连),并进行对比。结果205例患儿均顺利完成手术,麻醉方式均为外涂复方利多卡因乳膏,术后均使用吸收性明胶海绵包扎伤口内层,外层使用自粘绷带包扎固定。术后5d左右均自行在家拆除绷带。两组手术时间、术中出血量比较,差异具有统计学意义(P<0.05);但患儿创口水肿时间、术后疼痛评分、金属钛钉全部脱落时间、完全愈合时间、术后阴茎美观满意度比较,差异无统计学意义(P>0.05);两组术后均无系带损伤并发症;两组术后感染率、1个月包皮再次粘连发生率比较,差异无统计学意义(P>0.05)。结论改良单人操作法应用DCSD行小儿包皮环切术具有极强的临床可行性、实用性,选择合适的麻醉方式及材料可极大地减轻患儿疼痛。

Objective To summarize the clinical experience,surgical techniques,clinical effects and postoperative complications of modified single-person with application of disposable circumcision suture device(DCSD)in pediatric circumcision.Methods A total of 205 children that underwent circumcision in the National Hospital of Enshi Tujia and Miao Autonomous Prefecture from May 2018 to August 2020 using DCSD were reviewed retrospectively.102 cases in the observation group(modified single-person operation),and 103 cases in the control group(double-person operation)were documented.The surgical time,intraoperative blood loss,postoperative edema,postoperative pain score,the time of titanium pin defulvium,totally healing of incision,appearance of satisfaction and postoperative complications(injure of penile frenulum,infection,and foreskin re-adhesion after 1 month)of the two groups were collected and analyzed.Results All 205 children were successfully completed the operation.The anesthesia method was smearing penile body externally with compound lidocaine cream.After the operation,the inner layer of the wound was wrapped with absorbable gelatin sponge and the outer layer was fixed with a self-adhesive bandage.The bandage was removed at home about 5 days after the operation.There were statistically significant differences between the two groups in operative time and intraoperative blood loss(P<0.05).But postoperative edema,postoperative pain score,totally healing of incision,the time of titanium pin defulvium,appearance of satisfaction and totally healing of incision had no obvious difference between the two groups(P>0.05).There was no injure of penile frenulum both in the two groups.There were no statistically significant differences between the two groups in postoperative infection and foreskin re-adhesion after 1 month(P>0.05).Conclusions Modified single-person with application of DCSD in pediatric circumcision has extremly strong clinical feasibility and practicality,choosing appropriate anesthesia methods and materials to greatly reduce the painness of children,and it is worthy of popularization.