中国修复重建外科杂志

中国修复重建外科杂志

改良 Brisson 术治疗重度隐匿性阴茎疗效分析

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目的 探讨改良 Brisson 术治疗重度及部分合并明显肥胖的隐匿性阴茎疗效。 方法 回顾性分析 2014 年 1 月—2016 年 8 月采用改良 Brisson 术治疗的 96 例重度隐匿性阴茎患儿临床资料,其中合并明显肥胖 53 例。患儿年龄 1 岁~11 岁 9 个月,平均 5 岁 3 个月。采用阴茎阴囊正中纵切口替代阴茎阴囊交界处楔形皮肤切口,充分暴露术野;充分松解并切除阴茎周围异常肉膜及筋膜组织;利用原位推进及旋转皮瓣匹配包皮内板,完全去除皮肤狭窄。术后定期随访,采用 Boemers 标准评价术后疗效。 结果 术后切口均 Ⅰ 期愈合,包皮皮瓣无感染、坏死发生。93 例患儿获随访,随访时间 1 年~3 年 6 个月,平均 2 年 4 个月。术后 48 h 内出现 2 例阴囊血肿、5 例阴茎皮肤水肿,1 例术后 1 个月阴茎阴囊角切口处出现瘢痕增生。90 例患儿阴茎体显露良好,立位及端坐位均无阴茎体退缩,家属对阴茎外观满意;3 例显露一般,端坐位时阴茎部分回缩入耻骨前脂肪,阴茎皮肤附着部分松脱,影响外观。 结论 采用改良 Brisson 术治疗重度及合并肥胖的隐匿性阴茎,并发症少,效果满意。

Objective To discuss the effectiveness of modified Brisson surgery in treatment of the severe and obviously obese concealed penis. Methods The clinical data of 96 boys with severe concealed penis, of 53 cases combined with obviously obese, who were treated by modified Brisson surgery between January 2014 and August 2016, were retrospectively analysed. The children ranged in age from 1 year to 11 years and 9 months, with an average of 5 years and 3 months. The median longitudinal incision of the penis scrotum was used instead of the wedge-shaped skin incision at the junction of the penis and scrotum, which could completely expose the surgical field; fully release and removal of the abnormal meat membrane and fascia around the penis were performed; the propulsion and rotating flaps match the inner sheath of the foreskin was used to completely remove skin stenosis. Postoperative effectiveness was evaluated by Boemers standard. Results All the incisions healed by first intention and no infection or necrosis of the foreskin flap occurred. Ninety-three cases were discharged from hospital after operation and followed up 1 year to 3 years and 6 months, with an average of 2 years and 4 months. Scrotal hematoma occurred in 2 cases within 48 hours, penile skin edema of different degrees occurred in 5 cases, and scar hyperplasia in the penis scrotal corner incision occurred in 1 case at 1 month after operation. Postoperative exposure of the penis was good in 90 cases; there was no retraction of the penis in the upright position and sitting position; the family members were satisfied with the appearance of the penis. The penis were partially retracted in 3 cases, that affected the appearance of the penis during the sitting position. Conclusion The modified Brisson surgery is one of the most effective methods to treat the severe and obviously obese concealed penis, with satisfactory effectiveness and less complication.

关键词: 重度隐匿性阴茎; 改良 Brisson 术; 先天性畸形

Key words: Severe concealed penis; modified Brisson surgery; congenital malformation

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1. 张金哲. 小儿外科学. 北京: 人民卫生出版社, 2013: 1400-1402.
2. 李旭良. 小儿隐匿阴茎的诊断与治疗. 中华小儿外科杂志, 2011, 32(11): 859-860.
3. Boemers TM, De Jong TP. The surgical correction of buried penis: a new technique. J Urol, 1995, 154(2 Pt 1): 550-552.
4. Higuchi TT, Yamaguchi Y, Wood HM, et al. Evaluation and treatment of adult concealed penis. Curr Urol Rep, 2012, 13(4): 277-284.
5. Shiraki IW, Shirai RS. Congenital micropenile skin sleeve. J Urol, 1975, 114(3): 469-472.
6. Johnston JH. Concealed (beried) penis//Divid-Frank JV, Johnston JH, eds. Opervtive pediatric urology. Edinburgh: Churchil Livingstone, 1990: 233-235.
7. Maizels M, Zaontz M, Donovan J, et al. Surgica1 correction of the buried penis: description of a classification system and a technique to correct disorder. J Urol, 1986, 136(1 Pt 2): 268-271.
8. Devine CJ. Concealed and webbed penis//Himan F, eds. Atlas of pediatric urologic surgery. Philadeplia: Saunders, 1994: 608.
9. Brisson P, Patel H, Chan M, et al. Penoplasty for buried penis in children: report of 50 cases. J Pediatr Surg, 2001, 36(3): 421-425.
10. Kim JJ, Lee DG, Park KH, et al. A novel technique of concealed penis repair. Eur J Pediatr Surg, 2014, 24(2): 158-162.
11. 周学锋, 张文, 朱天琦, 等. 改良 Shiraki 手术治疗隐匿性阴茎. 中华小儿外科杂志, 2011, 32(11): 805-808.
12. Salgado CJ, Monstrey S, Hoebeke P, et al. Reconstruction of the penis after surgery. Urologic Clinicsof North America, 2010, 37(3): 379-401.
13. 李旭良, 龚以榜, 林涛, 等. 小儿埋藏性阴茎的诊断与外科治疗. 中华小儿外科杂志, 1996, 17(4): 215-217.
14. 杨光华, 张先觉, 周家杰, 等. 应用改良 Devine 术治疗小儿隐匿阴茎. 中华小儿外科杂志, 2005, 26(2): 68-70.
15. 杨华军, 徐哲明, 唐达星, 等. Sugita 法治疗重度隐匿阴茎. 中华小儿外科杂志, 2010, 31(6): 480-482.
16. Mirastschijski U, Schwenke C, Melchior S, et al. Buried penis: A comprehensive review on aetiology, classification and plastic-surgical reconstruction. Handchir Mikrochir Plast Chir, 2017, 49(2): 78-84.