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目的探讨采用经阴茎腹侧阴囊衔接处楔形裁剪联合改良Brisson术矫治先天性隐匿阴茎的疗效。方法 2010年3月-2012年6月,对68例先天性隐匿阴茎患儿采用经阴茎腹侧阴囊衔接处楔形裁剪联合改良Brisson术矫治。年龄3个月～13岁,中位年龄4岁10个月。隐匿阴茎分型:包茎型14例,索带型14例,中度型20例,重度型20例。阴茎体发育良好,均未合并畸形。术后观察并发症发生情况,采用自行设计随访问卷评定疗效。结果术后早期11例发生并发症,其中包皮外口明显粘连4例,阴囊皮肤肿胀5例,包皮远端坏死2例;远期9例发生并发症,其中腹部切口瘢痕形成4例,包皮口瘢痕狭窄3例,阴茎短小2例。其余患儿切口均Ⅰ期愈合。术后54例获随访,随访时间6～12个月,平均8个月。术后6个月根据自行设计随访问卷评定,患儿家长对术后整体观效果满意率达77.78%(42/54),认为临床症状完全改善率达85.19%(46/54);其中50例家长对阴茎显露满意,46例家长对患儿阴茎显露情况无心理负担,均显著优于术前(P<0.05);术后29例(53.70%)患儿自身对阴茎显露情况无心理负担,与术前18例(33.33%)比较,差异无统计学意义(χ2=1.22,P=0.31)。结论应用经阴茎腹侧阴囊衔接处楔形裁剪联合改良Brisson术可有效矫治先天性隐匿阴茎。
Objective To investigate the curative effect of congenital implicit penis by wedge-shaped incision of penile ventral scrotal junction and modified Brisson’s surgery. Methods From March 2010 to June 2012, 68 cases of congenital hidden penis were treated with wedge-shaped incision of the penis ventral scrotal joint and modified Brisson operation. Aged 3 months to 13 years old, the median age of 4 years and 10 months. Hiding penis type: phimosis in 14 cases, cord 14 cases, moderate 20 cases, severe 20 cases. Penile body well developed, no merger deformity. Postoperative complications were observed, with self-designed follow-up questionnaire to assess the efficacy. Results In the early postoperative period, complications occurred in 11 cases. There were 4 cases of obvious adhesions in the prepuce, 5 cases of scrotal skin swelling and 2 cases of distal necrosis of the foreskin. Complications occurred in 9 cases in the long term, including 4 cases of abdomen scar formation, 3 cases of scar stenosis, 2 cases of short penis. The rest of children incision healed first. 54 patients were followed up for 6 to 12 months with an average of 8 months. Six months after operation, self-designed follow-up questionnaire was used to evaluate the overall postoperative satisfaction. The satisfaction rate of the parents was 77.78% (42/54), and the complete improvement rate of clinical symptoms was 85.19% (46/54). Among them, 50 Parents were satisfied with the penis, 46 cases of parents had no psychological burden on the penis revealed, which were significantly better than preoperative (P <0.05); 29 cases (53.70%) had no psychological burden on the penis after operation, Compared with 18 cases before operation (33.33%), the difference was not statistically significant (χ2 = 1.22, P = 0.31). Conclusion The application of wedge-shaped cutting through the penile ventral scrotum junction combined with modified Brisson surgery can effectively correct the congenital hidden penis.