生物膜牵拉固定法在小儿先天性单纯阴茎弯曲矫正中的应用
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摘要
目的探讨生物膜牵拉固定法在先天性单纯阴茎弯曲畸形矫正术中的应用效果。方法回顾性分析广州市第一人民医院泌尿外科2010年1月至2017年6月收治的9例先天性单纯阴茎弯曲畸形患儿,所有患儿均采用生物膜牵拉固定法。术中将包皮脱套后,将生物膜缝合于弯曲凸点的白膜上,保持一定的纵向牵拉张力并多点缝合固定,使阴茎体被动伸直,阴茎弯曲暂时矫正,重新缝合包皮,用止血海绵覆盖切口,再使用高分子绷带包扎并固形,将阴茎头悬吊,使阴茎保持伸展竖直状态,定期换药,加压包扎阴茎体10 d。结果术后随访12～28个月,1例出现切口感染,予多次换药并外涂百多邦,2周后感染控制;1例龟头血运减少,予重新包扎后好转,所有患儿3周后包皮水肿均消退,2例术后出现阴茎背侧硬结,术后6个月自然消退。8例患儿阴茎弯曲完全矫正,1例重度弯曲的患儿术后阴茎仍有弯曲,但小于30°。结论在小儿先天性单纯阴茎弯曲矫正中,生物膜牵拉固定法能有效矫正阴茎弯曲,且并发症少,值得推广。
Objective To investigate the application and clinical effect of biofilm traction fixation in the treatment of congenital penile curvature in children. Methods The clinical data of 9 children with congenital penile curvature, who admitted to Department of Urology of the First People's Hospital of Guangzhou from Jan. 2010 to Jun. 2017,were analyzed retrospectively. The patients were treated surgically as follows: after degloved of foreskin, the biofilm was sutured and fixed on the cavernosa of the curvature bump of penis. The longitudinal tension was maintained by biofilm and the penis was kept straightened and the curvature was temporarily rectified. After the foreskin was sutured again, the incision was covered by hemostatic sponge, then the penis was encompassed by orthopedic casting tape. The penis was kept straight under pressure for 10 days. Results After 12 to 28 months' follow-up, incision infection occurred in 1 patients, and the infection was controlled after 2 weeks with several times dressing and external application of mupirocin ointment; one patient had decreased blood supply of the glans penis, which improved after re-bandaging. The edema of prepuce subsided after 3 weeks in all the children. Scleroma of penis occurred in 2 cases and it disappeared after 6 months. Eight cases were cured completely, and 1 case with severe curvature had curvature less than 30 degrees.Conclusion In the correction of congenital curvature of penis in children, biofilm traction fixation could effectively correct penis curvature and has fewer complications, which is worthy of popularizing.
Objective To investigate the application and clinical effect of biofilm traction fixation in the treatment of congenital penile curvature in children. Methods The clinical data of 9 children with congenital penile curvature, who admitted to Department of Urology of the First People's Hospital of Guangzhou from Jan. 2010 to Jun. 2017,were analyzed retrospectively. The patients were treated surgically as follows: after degloved of foreskin, the biofilm was sutured and fixed on the cavernosa of the curvature bump of penis. The longitudinal tension was maintained by biofilm and the penis was kept straightened and the curvature was temporarily rectified. After the foreskin was sutured again, the incision was covered by hemostatic sponge, then the penis was encompassed by orthopedic casting tape. The penis was kept straight under pressure for 10 days. Results After 12 to 28 months' follow-up, incision infection occurred in 1 patients, and the infection was controlled after 2 weeks with several times dressing and external application of mupirocin ointment; one patient had decreased blood supply of the glans penis, which improved after re-bandaging. The edema of prepuce subsided after 3 weeks in all the children. Scleroma of penis occurred in 2 cases and it disappeared after 6 months. Eight cases were cured completely, and 1 case with severe curvature had curvature less than 30 degrees.Conclusion In the correction of congenital curvature of penis in children, biofilm traction fixation could effectively correct penis curvature and has fewer complications, which is worthy of popularizing.
引文
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[10]KAMADA Y,SAKAMOTO A,TABUCHI K,et a1.OPening the anterior vaginal vault:a novel approach to vaginopl88ty with a modified McIndoe procedure using an artificial dermis[J].J Pediatric&Adolescent Gynecology,2014,28(5):119-122.
[11]DING JX,CHEN LM,ZHANG XY,et a1.Sexual and functional outcomes of vaginoplasty using acelluar porcine small intestinal submucosa graft or laparoscopic peritoneal vaginoplasty:a comparative study[J].Hum Reprod,2015,30(3):518-589.
[12]李升红,万婷,刘宏伟,等.血管紧张素Ⅱ2型受体阻滞剂对小鼠全层皮肤缺损创面愈合的研究[J].中国病理生理杂志,2013,29(7):1255-1259.
[13]李春景,刘国庆,王剑锋,等.阴茎根部背侧生物膜固定在隐匿性阴茎治疗中的作用[J].海南医学,2019,30(1):78-81.
[14]李春景,刘国庆,王剑锋,等.止血海绵非加压包扎法对尿道下裂术后切口预后的影响[J].海南医学,2016,27(18):3040-3041.
[2]DONNAHOO KK,CAIN MP,POPE JC,et al.Etiology,management and surgical complications of congenital chordee without hypospadias[J].Journal of Urology,1998,160(2):1120-1122.
[3]VICINI P,NICOLA SD,ANTONINI G,et al.Geometrical modified nesbit corporoplasty to correct different types of penile curvature:description of the surgical procedure based on geometrical principles and long-term results[J].International Journal of Impotence Research,2016,28(6):209-215.
[4]THIOUNN N,MISSIRLIU A,ZERBIB M,et al.Patient satisfaction with correction of congenital penile curvature[J].Actas Urologicas Espanolas,2018,42(6):414-419.
[5]王忠,李文吉,姚海军,等.16点法阴茎白膜折叠术治疗86例阴茎弯曲的长期疗效观察[J].中华泌尿外科杂志,2014,35(12):931-935.
[6]BALDINI A,MORELJOURNEL N,PAPAREL P,et al.Patient-reported long-term sexual outcomes following plication surgery for penile curvature:A retrospective 58-patient study[J].Progres En Urologie,2017,24(13):10-16.
[7]陆福鼎,玄绪军,许可慰,等.单纯性阴茎弯曲畸形手术治疗的选择及体会[J].山东大学学报(医学版),2014,52(10):86-89.
[8]姜海洋,栾华,刘晓红,等.阴茎缝深面条索样结构组织学观察[J].中国全科医学,2013,16(42):4336-4337.
[9]CANNING DA.Re:Further Analysis of the Glans-Urethral Meatus-Shaft(GMS)Hypospadias Score:Correlation with Postoperative Complications[J].Journal of Urology,2016,195(3):739-740.
[10]KAMADA Y,SAKAMOTO A,TABUCHI K,et a1.OPening the anterior vaginal vault:a novel approach to vaginopl88ty with a modified McIndoe procedure using an artificial dermis[J].J Pediatric&Adolescent Gynecology,2014,28(5):119-122.
[11]DING JX,CHEN LM,ZHANG XY,et a1.Sexual and functional outcomes of vaginoplasty using acelluar porcine small intestinal submucosa graft or laparoscopic peritoneal vaginoplasty:a comparative study[J].Hum Reprod,2015,30(3):518-589.
[12]李升红,万婷,刘宏伟,等.血管紧张素Ⅱ2型受体阻滞剂对小鼠全层皮肤缺损创面愈合的研究[J].中国病理生理杂志,2013,29(7):1255-1259.
[13]李春景,刘国庆,王剑锋,等.阴茎根部背侧生物膜固定在隐匿性阴茎治疗中的作用[J].海南医学,2019,30(1):78-81.
[14]李春景,刘国庆,王剑锋,等.止血海绵非加压包扎法对尿道下裂术后切口预后的影响[J].海南医学,2016,27(18):3040-3041.