摘要
目的比较采用阴茎腹侧Z形交叉皮瓣与阴茎背侧带蒂转移皮瓣在小儿隐匿阴茎成形术中的疗效。方法回顾性分析2017年1月至2019年6月华中科技大学同济医学院附属武汉儿童医院行阴茎成形术的151例隐匿阴茎患儿的临床资料。根据手术方式分组,其中69例采用阴茎腹侧Z形交叉皮瓣,为Z形皮瓣组;82例采用阴茎背侧带蒂转移皮瓣,为转移皮瓣组。Z形皮瓣组患儿年龄(5.23±0.58)岁;其中阴囊紧小33例,术前阴茎长度(3.06±0.25)cm;阴囊松弛36例,术前阴茎长度(2.99±0.28)cm。转移皮瓣组患儿年龄(5.20±0.63)岁;其中阴囊紧小39例,术前阴茎长度(3.04±0.30)cm;阴囊松弛43例,术前阴茎长度(3.04±0.24)cm。两组患儿年龄、术前阴茎长度的差异均无统计学意义(P>0.05)。比较两组术后阴茎伸长长度及并发症(如阴茎体回缩、包皮水肿、包皮口狭窄、阴茎伤口裂开等)情况。结果151例随访6~12个月,阴茎外形满意,无阴茎头坏死,无尿道瘘。Z形皮瓣组中,33例阴囊紧小患儿术后阴茎较术前伸长(2.47±0.22)cm,36例阴囊松弛患儿术后阴茎伸长(2.61±0.27)cm。转移皮瓣组中,39例阴囊紧小患儿术后阴茎伸长(2.90±0.16)cm,与Z形皮瓣组中阴囊紧小患儿阴茎伸长的比较差异有统计学意义(P<0.05);转移皮瓣组中43例阴囊松弛患儿阴茎伸长(2.79±0.18)cm,与Z形皮瓣组中阴囊松弛患儿阴茎伸长的比较差异有统计学意义(P<0.05)。Z形皮瓣组33例阴囊紧小患儿中,阴茎回缩2例,包皮口狭窄1例,包皮水肿2例,阴茎伤口裂开2例;36例阴囊松弛患儿中,包皮水肿1例。转移皮瓣组39例阴囊紧小患儿中,包皮水肿1例,并发症发生率明显低于Z形皮瓣组阴囊紧小患儿[2.56%(1/39)与21.21%(7/33),P=0.033];转移皮瓣组阴囊松弛患儿中阴茎回缩3例,包皮口狭窄3例,阴茎腹侧包皮水肿2例,阴茎伤口裂开1例,并发症发生率明显高于Z形皮瓣组阴囊松弛患儿[20.93%(9/43)与2.78%(1/36),P=0.038]。结论无论对于阴囊紧小还是阴囊松弛患儿,转移皮瓣组延长阴茎的效果均优于Z形皮瓣组,但转移皮瓣组阴囊紧小患儿和Z形皮瓣组阴囊松弛患儿并发症的发生率低。对于阴囊紧小患儿可采用阴茎背侧带蒂转移皮瓣手术,对于阴囊松弛的患儿可采用阴茎腹侧Z形交叉皮瓣手术。
Objective To explore the clinical effects of penile ventral Z-shaped cross flap and penile dorsal pedicled transfer flap in penoplasty for concealed penis.Methods From January 2017 to June 2019,the data of 151 patients with concealed penis admitted to our hospital was retrospectively reviewed.The patients were divided into 2 groups according to the surgical method.69 cases were treated with penis ventral Z-shaped cross flap to form penis and 82 cases were treated with dorsal penis pedicled flaps to form the penis.In Z-shaped flap group,the penis length of 33 patients with tight scrotum was(3.06±0.25)cm before surgery and the penis length of 36 patients with relaxed scrotum was(2.99±0.28)cm before surgery.In flap with transfer group,the penis length of 39 patients with tight scrotum was(3.04±0.30)cm before surgery and the penis of 43 patients with relaxed scrotum was(3.04±0.24)cm before surgery.The length of the penis after surgery and incidence of postoperative complications were compared between Z-shaped flap group and flap with transfer group.Common complications included penile body retraction,foreskin edema,foreskin stenosis and penile wound splitting.Results 151 patients were followed up for 6-12 months,and all patients were satisfied with penis appearance.There was no penile necrosis or urinary fistula.In Z-shaped flap cross group,the penis length of 33 patients with tight scrotum extended(2.47±0.22)cm after surgery.The penis length of 36 patients with scrotum relaxation extended(2.61±0.27)cm after surgery,39 patients was adopted the penile dorsal pedicled transfer flap with scrotum tight had extended penis(2.90±0.16)cm,which significantly different from the Z-shaped flap group(P<0.05).In flap with transfer group,43 patients with relaxed scrotum extended(2.79±0.18)cm after surgery,which was significantly different from the Z-shaped flap group(P<0.05).In Z-shaped flap group,33 patients with scrotum tight,there were 2 cases of penile retraction,1 case of stenosis of the foreskin,2 cases of foreskin edema,2 cases of penile wound rupture.In transfer flap group,of 39 patients with scrotum tight,there was 1 case of foreskin edema.The incidence of complications that adopted the penile dorsal pedicled transfer flap with scrotum tight was lower than those adopted penile ventral Z-shaped cross flap[2.56%(1/39)vs.21.21%(7/33),P=0.033].In transfer flap group,of the 43 patients with scrotum relaxation,there were 3 cases of penile retraction,3 cases of foreskin stenosis,2 cases of penile ventral foreskin edema,and 1 case of penile wound rupture.Z-shaped flap group:36 patients was scrotum relaxation was 1 case of foreskin edema.The incidence of complications that adopted the penile dorsal pedicled transfer flap was higer than those adopted penile ventral Z-shaped flap[20.93%(9/43)vs.2.78%(1/36),P=0.038].Conclusions In terms of children with tight scrotum or loose scrotum,the effect of the transfer flap method to extend the penis is better than that of the Z-shaped flap method.However,the transfer flap method has a low complication rate for children with tight scrotum,while the Z-shaped flap method has a low complication rate for children with loose scrotum.
作者
李刚
李爽
游嘉
王军
陈海涛
雷伟
徐浩伦
杨春雷
肖和
程银涛
Li Gang;Li Shuang;You Jia;Wang Jun;Chen Haitao;Lei Wei;Xu Haolun;Yang Chunlei;Xiao He;Cheng Yintao(Department of Urology,Wuhan Children’s Hospital,Wuhan Maternal and Child Healthcare Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430016,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第5期365-369,共5页
Chinese Journal of Urology
