3种包皮环切术的临床疗效分析

目的:比较传统包皮环切术、袖套状包皮切除术和包皮环切吻合术治疗包皮过长或包茎患者的临床疗效。方法:回顾性分析我院泌尿外科门诊采用传统包皮环切术(n=279)、袖套状包皮切除术(n=354)和包皮环切吻合术(n=285)治疗包茎或包皮过长918例患者的临床资料,比较3种术式手术时间、术中出血量、手术者对手术的满意度、术后4 h和7 d视觉模拟疼痛评分、术后并发症、创口完全愈合时间、包皮水肿程度、患者对术后外观的满意程度及围手术期费用等指标。结果:包皮环切吻合术在手术时间和术中出血量等方面要优于袖套状包皮切除术和传统包皮环切术(P<0.05)。传统包皮环切术、袖套状包皮切除术和包皮环切吻合术的创口完全愈合时间分别为(18.6±5.2)d、(11.4±3.7)d、(20.3±5.7)d,表明袖套状包皮切除术创口完全愈合时间明显优于传统包皮环切术和包皮环切吻合术(P<0.05)。袖套状包皮切除术在手术者对手术的满意度、术后水肿程度、术后并发症以及患者对外观的满意度等方面与包皮环切吻合术相似,但要优于传统包皮环切术(P<0.05)。传统包皮环切术和袖套状包皮切除术在术后7 d视觉疼痛模拟评分和围手术期费用上明显低于包皮环切吻合术(P<0.05)。结论:3种术式各有优缺点,最终的术式选择需根据患者的年龄、经济承受能力和手术者对不同术式的手术技巧差异和熟悉程度等多方面来考虑。

Shang Ring,sleeve and conventional circumcisions for redundant prepuce and phimosis: A comparative study of 918 cases

Objective: To compare the clinical effects of conventional,sleeve and Shang Ring circumcisions in the treatment of redundant prepuce and phimosis.Methods: We reviewed the clinical data of 918 patients with redundant prepuce or phimosis,279 treated by conventional circumcision,354 by sleeve circumcision and 285 by Shang Ring circumcision.We documented the preoperative characteristics,intra-operative blood loss,operation time,4-hour and 7-day postoperative visual analogue scores,surgeons' satisfaction,incision healing time,degrees of preputial edema,postoperative complications,patients' satisfaction with penile appearance and peri-operative cost,and compared them among the three groups.Results: Shang Ring circumcision significantly reduced the operation time and intra-operative blood loss as compared with conventional and sleeve circumcisions(P<0.05).The postoperative incision healing time was(18.6±5.2) d in the conventional circumcision group,(11.4±3.7) d in the sleeve circumcision group and(20.3±5.7) d in the Shang Ring circumcision group,significantly shorter in the sleeve group than in the other two(P< 0.05).As for the surgeons' satisfaction,postoperative complications,degree of preputial edema and patients' satisfaction with penile appearance,sleeve circumcision showed similar effects to Shang Ring circumcision but significantly better than conventional circumcision(P<0.05).The 7-day postoperative visual analogue score and peri-operative cost were significantly lower in the conventional and sleeve circumcision groups than in the Shang Ring group(P<0.05).Conclusion: Each of the three circumcision methods has its own advantages and disadvantages.The treatment decision should be individualized and based on a comprehensive consideration of the patients' age and economic status as well as surgeons' advice and surgical skills.