基于尿道下裂手术皮瓣转移思路矫治隐匿阴茎的效果分析

Curative effect analysis of treating concealed penis based on the idea of flap transfer in the treatment of hypospadias

目的:探讨基于尿道下裂手术皮瓣转移思路矫治隐匿阴茎的临床应用效果。方法:回顾性分析2017年7月至2021年7月成都市第二人民医院泌尿外科和四川省人民医院儿童医学中心小儿外科收治的隐匿阴茎患儿的临床资料。对照组采用传统手术方式,试验组采用基于尿道下裂手术皮瓣转移思路的改良手术方式。统计分析2组术后皮瓣缺血、水肿、皮肤裂开等近期并发症情况,以及术后6个月阴茎外观的Boemers评级(良好、一般、不良)、温哥华瘢痕量表(VSS)评估的瘢痕增生情况(轻度、中度、重度)及阴茎整体外形情况(塔形、圆柱形、倒塔形)。计数资料采用卡方检验进行分析。结果:共纳入298例患儿,年龄2.5~13.7岁,平均6.4岁。对照组103例,试验组195例。所有入组患儿均一期顺利完成手术,术后3~4 d出院,平均恢复时间3~4周。术后随访时间均>6个月。对照组术后出现皮瓣缺血2例(1.9%),皮肤裂开3例(2.9%),试验组术后2例(1.0%)患儿出现皮肤裂开,2组的近期并发症发生率的差异无统计学意义[4.9%(5/103)vs.1.0%(2/195),P>0.05]。试验组Boemers评级"良好"的比例高于对照组[93.3%(182/195)vs.71.8%(74/103),P<0.01]。试验组VSS评估的中重度瘢痕增生的比例小于对照组[6.2%(12/195)vs.26.2%(27/103),P<0.01]。试验组阴茎整体外形呈接近正常阴茎的圆柱形的比例明显高于对照组[81.5%(159/195)vs.60.2%(62/103),P<0.01]。结论:基于尿道下裂手术皮瓣转移思路矫治隐匿阴茎的改良术式与传统手术方式相比,更注重皮瓣的整体规划及筋膜层的张力分布,可更有效解决隐匿阴茎皮肤覆盖不足的问题,减少术后瘢痕形成,外生殖器外观自然且更接近正常,手术效果确切,术后远期并发症发生率低。

Objective To investigate the clinical effect of surgical treatment of concealed penis based on the idea of flap transfer in the treatment of hypospadias.MethodsRetrospectively analyzed the clinical data of children with concealed penis admitted to the Urology Department of Chengdu Second People’s Hospital and Department of Pediatric Surgery at Children’s Medical Center of Sichuan Provincial People’s Hospital,from July 2017 to July 2021.The control group used the traditional surgical method and the experimental group used a modified surgical approach based on the idea of flap transfer in the treatment of hypospadias.Short-term complications such as flap ischemia,edema,and skin dehiscence were statistically analyzed in the two groups,as well as the Boemers rating of penile appearance(good,general,poor),Vancouver scar scale(VSS)(mild,moderate,severe),overall penis shape(tower,cylindrical,inverted tower)at 6 months after surgery.Count data were analyzed using the Chi-square test.Results298 children,aged 2.5 to 13.7 years,with a mean age of 6.4 years,were enrolled in the study.103 children were in the control group,and 195 children were in the experimental group.All enrolled patients were operated successfully in the first stage and were discharged 3-4 days after the operation,with an average recovery time of 3-4 weeks.After a follow-up of more than 6 months,in the control group,2 cases(1.9%)of flap ischemia and 3 cases(2.9%)of skin dehiscence occurred after surgery.Two children(1.0%)in the experimental group had skin dehiscence after surgery,and the difference in the recent complication rate between the two groups was not significant[4.9%(5/103)vs.1.0%(2/195),P>0.05].The proportion of Boemers rated"good"in the experimental group was higher than that in the control group[93.3%(182/195)vs.71.8%(74/103),P<0.01].The proportion of moderate to severe scarring assessed by VSS was lower in the experimental group than in the control group[6.2%(12/195)vs.26.2%(27/103),P<0.01].The proportion of the overall penis shape of the penis close to the cylindrical shape of the normal penis in the experimental group was significantly higher than that in the control group[81.5%(159/195)vs.60.2%(62/103),P<0.01].ConclusionCompared with the traditional surgical method,the modified surgical approach based on the idea of flap transfer in the treatment of hypospadias attaches more importance to the overall planning of the flap and the tension distribution of the fascial layer,which can be more effective to solve the problem of insufficient coverage of the concealed penile skin and reduce postoperative scar formation.Moreover,the appearance of the external genitalia is natural and closer to normal,the surgical effect is exact,and the long-term postoperative complications are lower.