阴茎皮瓣渐进性转移联合阴囊局部皮瓣在儿童重度隐匿性阴茎矫正中的应用

Application of progressive transfer of penile flap combined with local scrotal flap in correction of severe concealed penis in children

目的探讨阴茎皮瓣渐进性转移联合阴囊局部皮瓣矫正儿童重度隐匿性阴茎的临床效果。方法回顾性分析2021年7月至2023年7月郑州大学附属儿童医院收治的重度隐匿性阴茎患儿临床资料。采用阴茎皮瓣渐进性转移联合阴囊局部皮瓣对隐匿性阴茎进行矫正,术中去除少量多余的包皮内板,于阴茎背侧正中剪开包皮外板,将阴茎皮瓣自背侧向腹侧渐进无张力覆盖,阴囊局部皮瓣向上提起,缝合至系带处覆盖阴茎腹侧包皮缺损。记录术中出血量;术后观察患儿疼痛耐受程度、包皮水肿时间、阴茎延长长度、皮瓣愈合情况;对阴茎外观进行随访,观察阴茎体有无回缩,并询问患儿及监护人满意度。结果共纳入32例男性患儿,年龄3~10岁,平均7.2岁;患儿阴茎均呈圆锥形外观,阴茎体埋藏于耻骨前皮下,自然状态下难以触及阴茎体。术中平均出血量约5 ml。术后患儿均有疼痛,2例需止痛泵止痛,其余病例予吲哚美辛栓直肠给药后可耐受;术后包皮轻度水肿,7~9 d后出院时水肿基本消失;静态下阴茎延长1.5~3.0 cm,平均约2.0 cm;术后仅1例患儿阴囊皮瓣出现小范围(约5 mm×4 mm)感染,切口愈合不良,经换药、加强护理后瘢痕愈合,其余患儿皮瓣均成活良好。随访6~12个月,2例患儿阴茎在静态下长度较出院时稍有回缩,其余30例则无明显改变,患儿及监护人对手术效果均满意。结论阴茎皮瓣渐进性转移联合阴囊局部皮瓣矫正儿童重度隐匿性阴茎,可以充分延长阴茎体,且术后回缩程度低,阴茎外观良好,患者满意度高。

Objective To investigate the clinical effect of progressive transfer of penile flap combined with local scrotal flap in correction of severe concealed penis in children.Methods The clinical data of children with severe concealed penis admitted to the Children’s Hospital Affiliated to Zhengzhou University from July 2021 to July 2023 were retrospectively analyzed.The concealed penis was corrected by progressive transfer of penile flap combined with local scrotal flap.During the operation,a small amount of excess inner prepuce was removed and the outer prepuce was cut in the middle of the dorsal side of the penis.Then the penile flap was transferred from dorsal to ventral,gradually covering the wound without tension.The local scrotal flap was lifted upwards and sutured to the frenulum for covering the ventral foreskin defect of the penis.The amount of blood loss during the operation was recorded.The pain tolerance,the duration of prepuce edema,the length of penis extension and the healing of skin flap were observed.The appearance of the penis was followed up to observe whether the penis was retracted,and the satisfaction of the children and their guardians was recorded.Results A total of 32 male children were enrolled,ranging in age from 3 to 10 years,with an average age of 7.2 years.The penis of all the children had a conical appearance,and the penile shaft was buried under the subcutaneous anterior pubis,which was difficult to palpate in its natural state.The average intraoperative blood loss was about 5 ml.All patients had pain after the operation.Two patients needed a pump to relieve pain,and the rest could tolerate it after rectum administration of indomethacin suppositories.The edema of the prepuce was mild after the operation,and the edema basically disappeared when the patient was discharged 7-9 days later.The penis could be lengthened by 1.5-3.0 cm under static conditions,averaging about 2.0 cm.After surgery,only 1 patient had a small area(about 5 mm×4 mm)of infection in the scrotal flap and poor incision healing,and scar healing after dressing change and intensive nursing.The other flaps healed well.After 6 to 12 months of follow-up,the penis length of 2 cases was slightly retracted from the time of discharge,and the remaining 30 cases had no significant change.The patients and their guardians were satisfied with the operation results.Conclusion The progressive transfer of penile flap combined with local scrotal flap correction of severe concealed penis in children can fully lengthen the penile body,and the degree of postoperative retraction is low,the appearance of the penis is good,and the patient satisfaction is high.