不同手术时机和手术方式的包皮环切术治疗嵌顿性包茎的疗效分析

Analysis of the curative effect of circumcision for incarcerated phimosis with different operative timingand methods

目的探讨不同手术时机和手术方式的包皮环切术治疗嵌顿性包茎的临床效果。方法回顾性分析2016年2月至2022年1月因嵌顿性包茎在本院行包皮环切术的157例患者的临床资料,按照不同手术时机和不同手术方式分为一期传统组(37例)、二期传统组(25例)、二期吻合器组(41例)和二期缝合器组(54例),分析并比较四组的手术时间、术中出血量、术后疼痛评分(术后2h、术后7d)、术后并发症(血肿、水肿、感染、裂开)、创面愈合时间、阴茎外观满意度等指标。结果四组的手术时间分别为(39.3±6.6)、(34.3±6.5)、(5.7±1.5)和(9.9±2.3)min,二期吻合器组的手术时间均低于其余三组(均P<0.05);术中出血量分别为(11.8±3.9)、(9.8±2.6)、(1.2±0.9)和(1.8±1.1)mL,二期吻合器组的出血量均低于其余三组(均P<0.05);四组术后2h疼痛评分为(3.9±1.1)、(2.7±1.2)、(3.7±1.2)和(2.4±0.9)分,二期缝合器组和二期传统组的疼痛评分均低于其余两组(均P<0.05);四组术后7d疼痛评分为(2.1±1.1)、(1.3±0.9)、(2.7±1.1)和(1.0±0.8)分,二期缝合器组和二期传统组的术后7d疼痛评分均低于其余两组(均P<0.05);四组术后并发症发生率为67.6%、28.0%、43.9%和16.7%,二期缝合器组的并发症均低于其余三组比较(均P<0.05);四组创面愈合时间为(12.1±2.7)、(9.1±2.2)、(19.2±3.4)和(8.9±1.6)d,二期缝合器组和二期传统组的创面愈合时间均短于其余两组(均P<0.05);四组阴茎外观满意度评分为(6.9±1.3)、(7.8±1.2)、(8.6±1.0)和(9.2±0.8)分,二期缝合器组的满意度评分均高于其余三组(均P<0.05)。结论散嵌顿性包茎一期先行包皮复位术后二期应用包皮切割缝合器进行包皮环切术的临床疗效最好。

Objective To investigate the clinical effect of circumcision of incarcerated phimosis with different surgical timing and methods.Methods The clinical data of 157 patients undergoing circumcision due to incarcerated phimosis in our hospital from February 2016 to January 2022 were retrospectively analyzed.According to different operation timing and operation methods,they were divided into a first-stage traditional group(37 cases),a second-stage traditional group(25 cases),a second-stage anastomat group(41 cases)and a second-stage suture group(54 cases).The indexes of operation time,intraoperative blood loss,postoperative pain score(2 h,7 d after operation),postoperative complications(hematoma,edema,infection,split),wound healing time,penile appearance satisfaction and so on were analyzed and compared in the four groups.Results The operative time of the four groups was(39.3±6.6)min,(34.3±6.5)min,(5.7±1.5)min and(9.9±2.3)min,respectively.The operative time of the secondary stapler group was statistically significant compared with the other three groups(all P<0.05).The intraoperative blood loss was(11.8±3.9)mL,(9.8±2.6)mL,(1.2±0.9)mL and(1.8±1.1)mL,respectively,and the difference between the second stage stapler group and the other three groups was statistically significant(all P<0.05).The pain scores of the four groups at 2 h after surgery were(3.9±1.1)scores,(2.7±1.2)scores,(3.7±1.2)scores and(2.4±0.9)scores.The pain scores at 2 h after surgery of the second stage suture group and the second stage traditional group were statistically significant compared with the other two groups(all P<0.05).The pain scores of the four groups were(2.1±1.1)scores,(1.3±0.9)scores,(2.7±1.1)scores and(1.0±0.8)scores at 7 days after surgery.The pain scores at 7 days after surgery of the second stage suture group and the second stage traditional group were statistically significant compared with the other two groups(all P<0.05).The incidence of postoperative complications in the four groups was 67.6%,28.0%,43.9%and 16.7%.The complications in the secondary suture group were statistically significant compared with those in the other three groups(all P<0.05).The wound healing time of the four groups was(12.1±2.7)d,(9.1±2.2)d,(19.2±3.4)d and(8.9±1.6)d.The wound healing time of the second stage suture group and the second stage traditional group was the shortest compared with the other two groups,and the differences were statistically significant(P<0.05).The penile appearance satisfaction scores of the four groups were(6.9±1.3)scores,(7.8±1.2)scores,(8.6±1.0)scores and(9.2±0.8)scores,and the satisfaction scores of the second stage suture group were statistically significant compared with the other three groups(all P<0.05).Conclusions The clinical ffect of prepuce circumcision with the penile circumcision and suturing devices in the second stage after prepuce reduction in the first stage of incarcerated phimosis is the best.