阴茎浅筋膜深层切除在儿童重度隐匿性阴茎手术中的应用

Excision of the deep layer of dartos fascia in the treatment of congenital severe concealed penis in children

目的介绍一种基于阴茎浅筋膜解剖的儿童重度隐匿性阴茎的矫正技术。方法回顾性分析2021年1月至2022年12月郑州大学附属儿童医院泌尿外科收治的重度隐匿性阴茎患儿临床资料。术前常规进行反射性勃起试验。术中该矫正技术的要点包括:取阴茎腹侧正中联合阴囊弧形切口,术中阴茎浅筋膜被分为深浅2层,游离并切除浅筋膜深层,耻骨联合处皮下组织和真皮与阴茎根部白膜缝合固定,转移阴茎腹侧根部及阴囊皮肤与内板匹配覆盖阴茎体。术后随访并发症发生情况,并于术后6个月评价手术效果。结果共纳入54例患儿,年龄2.8~10.0岁,中位年龄6.7岁。其中43例患儿存在部分阴茎阴囊转位。在反射性勃起的情况下,患儿阴茎皮肤均严重不足。手术均顺利完成,术后呈包皮环切外观,43例合并部分阴茎阴囊转位均同期矫正。术后切口愈合良好,无感染及切口裂开。随访6~20个月,平均12个月,所有患儿均出现包皮轻度水肿,术后2~4周水肿消退。术后51例患儿阴茎体显露良好,阴茎皮肤无臃肿,阴茎无回缩,家属对阴茎外观满意;3例阴茎体显露改善,坐位时阴茎部分回缩,阴茎皮肤无臃肿。结论重度隐匿性阴茎皮肤严重不足,采用阴茎腹侧正中联合阴囊弧形切口入路,切除阴茎浅筋膜深层,阴茎根部及阴囊皮肤覆盖阴茎体,术后呈包皮环切外观;术中可同期矫正阴茎阴囊转位,使外生殖器呈现最佳外观,具有良好的功能和美容效果。

Objective To present the experience of the anatomical of dartos fascia and describe a new technique for the correction of congenital severe concealed penis.Methods This retrospective study was conducted on patients with congenital severe concealed penis who underwent surgery at Department of Urology,Children’s Hospital Affiliated with Zhengzhou University from January 2021 to December 2022.Reflex erection tests were routinely performed before surgery.The technique involved creating a median longitudinal incision combined with a curved incision of the ventral penile skin,dividing and excising the deep layer of dartos fascia,fixing the subcutaneous dermis at the pubic symphysis with sutures to the tunica albuginea of the penile root,and transferring the skin of the ventral root of the penis and scrotum to match the internal plate to cover the shaft of the penis.Follow-up of complications occurred after surgery,and the surgical effect was evaluated 6 months after surgery.Results A total of 54 patients were enrolled,aged 2.8-10.0 years,with a median age of 6.7 years.In the presence of reflex erection,the penile skin was severely deficient in children with congenital severe concealed penis.The surgery was successfully completed,and the postoperative appearance was circumcised.In 43 cases with partial penile scrotal transposition,the transposition was corrected simultaneously.The incision healed well after surgery,with no infection or incisional dehiscence.Follow-up for 6 to 20 months,with an average of 12 months,showed mild edema of the prepuce in all children,which disappeared within 2 to 4 weeks after surgery.In 51 cases,the penis body showed good exposure,with no swelling of the penis skin and no retraction of the penis.The family members were satisfied with the appearance of the penis.The penis was partially retracted in 3 cases,that affected the appearance of the penis during the sitting position.Conclusion In congenital severe concealed penis with severe skin deficiency,a deep dartos fascia was excised using a ventral median penile combined with a curved scrotal incision approach,and the penile root and scrotal skin covered the penile body with a circumcised appearance after surgery.The scrotal transposition of the penis was corrected at the same time to give the external genitalia an optimal appearance and provide good functional and cosmetic result.