He Wenfei,Zhang Hongmei,Wang Cheng,et al.Prospective analysis of selecting penile diameter,circumcision stapler and foreskin cerclage in children.[J].Journal of Clinical Pediatric Surgery,2018,17(05):358-362.
基于阴茎发育规律的儿童包皮环切术式探讨
- Title:
- Prospective analysis of selecting penile diameter,circumcision stapler and foreskin cerclage in children.
- Keywords:
- Penis; Surgical Staplers; Circumcision; Male; Postoperative Complications; Child
- 文献标志码:
- A
- 摘要:
- 目的 根据儿童阴茎发育规律，探讨两种包皮环切术式与阴茎直径（d）选择的关系。 方法 收集本院包皮过长或包茎患儿共358例，其中包茎171例，包皮过长187例，患儿年龄4 ~ 16岁，年龄中位数（9.0 ± 2.2）岁；阴茎直径1.2 ~ 3.0 cm，中位数（1.5 ± 0.4 ）cm。按照家属自愿随机原则分组，A组应用一次性缝合器行包皮环切术，共191例；B组行包皮环扎术，共167例。分析阴茎直径发育趋势及两种术式术后并发症与阴茎直径之间的关系，比较两种术式手术时间、术中出血量和治疗费用以及术后30 d随访情况。 结果 ①儿童年龄与阴茎直径呈正相关性（r = 0.4，P < 0.05）。②A组与B组术后总并发症的发生率分别是5.24%(10/191)和2.40%(4/167)，差异无统计学意义(P = 0.18)；在1.2 cm ≤ d < 1.5 cm段，A组术后包皮粘连的发生率83.33%（10/12），B组无一例并发症，差异有显著统计学意义（P < 0.0001）。在1.5 cm ≤ d < 2.6 cm段，两组均无并发症。在d ≥ 2.6 cm段，A组无一例并发症，B组并发症的发生率为25%（4/16），差异有统计学意义（P = 0.03）。③A组和B组平均治疗费用分别为（2 105.81 ± 47.37）元和（526.63 ± 24.58）元，差异有统计学意义(P < 0.0001)。④术后30 d随访，A组一次性缝合钉未脱并包皮内板分粘率3.66%（7/191）；在1.2 cm ≤ d < 1.5 cm段，B组包皮结扎环未脱率7.19%（12/167），在d ≥ 2.6 cm段，两组差异无明显统计学意义(P = 0.16)。结论 儿童包皮环扎术和一次性缝合器包皮环切术有阴茎直径选择性，包皮环扎术适用于d <1.5 cm的包茎、包皮过长儿童或幼儿；一次性缝合器包皮环切术适用于d ≥ 2.6 cm的包茎、包皮过长大龄儿童或青少年；在1.5 cm ≤ d < 2.6 cm段，两种方法均可。
- Abstract:
- ObjectiveTo select penile diameter (d) according to the clinical efficacies of circumcision stapler and foreskin cerclage in children.MethodsA total of 358 children with phimosis or redundant prepuce were treated with circumcision stapler (group A) and foreskin cerclage (group B).The median age was 9.0±2.2(4~16) years and the median penile diameter 1.5±0.4(1.2~3.0) cm.The development trend of penile diameter was analyzed.And two groups were compared in terms of incidence and relationship of postoperative complications and/or penile diameter,operative duration,intraoperative blood loss,cost of treatment and 30day followups.ResultsAge was positively correlated with penile diameter (r=0.4,P<0.05).The incidences of postoperative complications of groups A and B were 5.24% (10/191) and 2.4% (4/167).There were no significant statistical differences (P=0.18).For 1.2 cm ≤d<1.5 cm,the perpetual adhesion of postoperative complications were 83.33% (10/12) in group A and 0% (0/25) in group B.There were significant statistical differences (P<0.0001);For 1.5 cm ≤d<2.6 cm,no postoperative complications occurred;For d≥2.6 cm,the postoperative complications was 0% (0/20) in group A versus 25% (4/16) in group B.There were significant statistical differences (P=0.03).The average treatment costs for groups A and B were (2105.81±47.37) and (526.63±24.58) RMB respectively.There were statistical significant differences (P<0.0001).During 30day followups,3.66% (7/191) required broken nail and stick in group A.For 1.2 cm ≤d<1.5 cm,7.19%(12/167) in group B;For d>2.6 cm,there were no significant statistical differences (P=0.16).ConclusionCircumcision stapler and foreskin cerclage have a diameter of penile selectivity in children.Foreskin cerclage is applicable for d<1.5 cm.However,circumcision stapler is suitable for d≥2.6 cm.
相似文献/References:
[1]熊晶 刘颖 魏光辉 刘星 张德迎 吴盛德. HoxA13基因在尿道下裂胎鼠阴茎中的表达及意义[J].临床小儿外科杂志,2011,10(05):341.
[J].Journal of Clinical Pediatric Surgery,2011,10(05):341.
[2]刘鸿坚 祁泳波 王千 张晋绥. 经阴茎腹侧松解固定术治疗小儿隐匿阴茎[J].临床小儿外科杂志,2012,11(05):366.
[J].Journal of Clinical Pediatric Surgery,2012,11(05):366.
[3]莫智峰 伍岗泉 翟国敏. 两种包扎方法在隐匿性阴茎手术伤口的应用[J].临床小儿外科杂志,2014,13(06):568.
[4]彭潜龙 赵夭望 李艳芳. 湖南地区正常男童阴茎睾丸发育的调查[J].临床小儿外科杂志,2015,14(05):395.
[5]唐悦,何大维,肖兴望.. 改良Devine术治疗儿童先天性埋藏阴茎的疗效分析[J].临床小儿外科杂志,2018,17(12):907.
Tang Yue,He Dawei,Xiao Xingwang,et al. Efficacy of fundiform ligament dissection plus penoscrotal flap transposition for congenital buried penis in children:a modified Devine procedure.[J].Journal of Clinical Pediatric Surgery,2018,17(05):907.
[6]曾莉,张志博,顾飞,等.阴茎腹侧翻斗状肉膜瓣覆盖技术在尿道下裂TIP手术中的应用研究[J].临床小儿外科杂志,2021,20(11):1031.[doi:10.12260/lcxewkzz.2021.11.007]
Zeng Li,Zhang Zhibo,Gu Fei,et al.Covering technique of ventral Dartos flap during tubularized incised plate urethroplasty for hypospadias and observation of curative efficacy[J].Journal of Clinical Pediatric Surgery,2021,20(05):1031.[doi:10.12260/lcxewkzz.2021.11.007]
[7]邹金涵,阮帅,周祎昕,等.改良阴茎延长及整形术与改良Devine术治疗隐匿性阴茎的临床疗效对比[J].临床小儿外科杂志,2022,21(11):1081.[doi:10.3760/cma.j.cn101785-202207010-015]
Zou Jinhan,Ruan Shuai,Zhou Yixin,et al.Comparison of clinical efficacy between modified penis lengthening and plastic surgery and modified Devine surgery for concealed penis[J].Journal of Clinical Pediatric Surgery,2022,21(05):1081.[doi:10.3760/cma.j.cn101785-202207010-015]
[8]张黄成昊,严兵,唐浩宇,等.儿童异位睾丸13例诊疗体会[J].临床小儿外科杂志,2022,21(11):1090.[doi:10.3760/cma.j.cn101785-202009028-017]
Zhang Huangchenghao,Yan Bing,Tang Haoyu,et al.Clinical diagnosis and treatment of 13 children with ectopic testis[J].Journal of Clinical Pediatric Surgery,2022,21(05):1090.[doi:10.3760/cma.j.cn101785-202009028-017]
[9]沈一丁,孙珑,燕翔.阴茎胚胎发育与尿道下裂发生的研究进展[J].临床小儿外科杂志,2024,(01):98.[doi:10.3760/cma.j.cn101785-202206002-020]
Shen Yiding,Sun Long,Yan Xiang.Research advances of penile embryonic development and hypospadias[J].Journal of Clinical Pediatric Surgery,2024,(05):98.[doi:10.3760/cma.j.cn101785-202206002-020]
[10]杨志林,张培良,何盈颖,等.阴茎头宽度和尿道板宽度对尿道下裂TIP手术后并发症的影响分析[J].临床小儿外科杂志,2024,(06):555.[doi:10.3760/cma.j.cn101785-202209022-009]
Yang Zhilin,Zhang Peiliang,He Yingying,et al.Impacts of glanular width and urethral plate width on tubularized incised plate urethroplasty complications in children with hypospadias[J].Journal of Clinical Pediatric Surgery,2024,(05):555.[doi:10.3760/cma.j.cn101785-202209022-009]