包皮环套术及传统包皮环切术的应用效果对比

目的 对比分析包皮环套术和包皮环切术两种术式在治疗成人与儿童包皮过长或包茎中的应用效果.方法 临床上顺序收集成人(18～35岁)及儿童(6～13岁)包皮过长或包茎患者197例,予以包皮环套术或包皮环切术.术后随访3个月,采用视觉模拟评分法(VAS)记录患者术后ld至10d的疼痛强度,同时记录各组患者的常见术后并发症情况,计算并发症发生率并作对比分析.结果 包皮环套术手术时间及术中出血量明显少于传统包皮环切术,成人环套组在术后1、3、7d时VAS评分明显高于儿童环套组,而儿童环切组在术后ld和5d评分明显高于环套组.成人组环套术和环切术后包皮水肿发生率分别是21％和10％,儿童组环套术后环切术后包皮水肿发生率分别是5％和15％.结论 儿童包皮过长或包茎患者更适合选择包皮环套术;成人包皮环套术的应用效果相对儿童较差,在行术式选择时最好结合患者要求,若要求较好术后包皮外观及较短手术时间可选择环套术.     

采用包皮除去环行成人包皮环切术

为了探讨ＧＭＳＤＳ 2包皮除去环(韩国ＧＭ商社 )行包皮环切术的疗效 ,我们对 12 0例患者进行了前瞻、对照性临床观察。报告如下。材料和方法　 1999年 9月～ 2 0 0 0年 7月连续 12 0例包皮过长成人患者 ,随机分为 2组 ,每组 6 0例 ,分别行传统包皮环切术和包皮除去环环切术。ＧＭＳＤＳ 2包皮除去环由内环、外环和弹力线组成。除去环手术方法 :消毒 ,阴茎根部局麻或无麻醉 ;将包皮后褪 ,内环置于冠状沟处 ,然后将多余的包皮复位 ,用外环将包皮卡在内环凹槽处 ;结扎弹力线 2根 ,每根 2～ 3圈。术后第 2ｄ剪去坏死包皮 ;术后第 5～ 6ｄ ,拆除…     

包皮内板切除矫治包皮过长

目的：评估包皮内板切除矫治包皮过长的效果。方法：将150例包皮过长患者随机分为包皮内板切除组（A组）和传统包皮环切组（B组）。A组患者90例,保留冠状沟处包皮内板5mm,保留系带10mm,切除其余包皮内板,使阴茎的血管和神经保持完整;B组患者60例,采用传统包皮环切术。对两组术中出血量、术后创口出血、血肿、水肿、疼痛、感染、等并发症以及阴茎外形满意度进行比较。结果：A组术中出血量为（5±3）ml,B组为（22±5）ml（P〈0.001）;A组术后疼痛持续时间为（12±4）h,B组为（36±10）h（P〈0.05）;A组术后阴茎外形满意度98.3%,发生创口水肿者0例,伴出血、血肿者0例,发生局部感染者1例,总并发症率为1.1%。B组阴茎外形满意度75%,术后创口出血、血肿1例,水肿4例,感染2例,总并发症率为10%（P〈0.05）。所有对比项目在两组之间的差异均有统计学意义。结论：包皮内板切除矫治包皮过长手术比传统的包皮环切术更具有优越性。     

包皮内外板一次环切术300例临床分析

目的总结包皮内外板一次环切术的疗效。方法300例患者行包皮内外板一次环切术,分离包皮阴茎头粘连,纵行剪开背侧包皮,环形切除过长的包皮,内外板对位间断缝合。结果术后出血10例,处理后恢复良好,290例效果满意。结论注意细节可保证手术成功,减少术后并发症。     

介绍一种包皮环切术的新缝合法

1992年至 1998年对 16 2例包皮过长、包茎患者行包皮环切术 ,术中采用新的缝合方法 ,现介绍如下。1　临床资料1 1　一般资料　　本组患者共 16 2例 ,平均年龄 10 (2～ 2 4)岁 ,在全麻或局麻下行包皮环切术。1 2　手术方法　　包皮切除范围与外科手术学[1] 介绍相同。缝合方法 :缝合包皮内外板时紧贴切缘缝合 (约 0 2ｍｍ ) ,两线旋转交叉一周 (36 0 )将内外板切缘拉拢 ,再由助手将备好油纱条放在交叉后的缝线外结扎固定 ,缝线线结打在油纱外 ,依此法缝合内外板一周约需 8～ 16针 ,一般 12针左右 ,术后包扎及护理无特殊。其缝合要点 :①缝…     

自粘弹力绷带在包皮环切术后的应用体会

目的评价自粘弹力绷带在包皮环切术后的临床应用价值。方法将120例患者随机分组,治疗组60例在包皮环切术后用凡士林纱条及无菌纱布覆盖,自粘弹力绷带固定;对照组60例在包皮环切术后用凡士林纱条及无菌纱布覆盖,胶布固定。两组术后均口服抗生素预防感染,成年患者口服乙烯雌酚预防阴茎勃起。结果治疗组术后出现伤口出血及血肿例数、包皮及系带水肿例数和伤口换药次数均低于对照组,有统计学意义（P〈0.05）;两组感染发生例数无统计学意义。结论自粘弹力绷带应用于包皮环切术后伤口固定具有操作简便、安全实用及可有效预防术后出现并发症的特点。     

自粘弹力绷带在包皮环切缝合器术中的应用

目的:观察自粘弹力绷带在一次包皮环切缝合器术中的安全性和有效性。方法:回顾性分析我院2014～2017年泌尿外科门诊就诊的147例包皮过长患者的临床资料,排除禁忌证,随机分为四组:传统包皮环切术+纱布组(A组)、传统包皮环切术+绷带组(B组)、环切缝合器组+纱布包扎组(C组)、环切缝合器+自粘弹力绷带组(D组),分别对手术时间、术中出血量、阴茎水肿程度进行测量。结果:D组和A组手术时间分别为(9±2)min和(25±3)min,D组和C组术后1h出血量分别为(0.5±0.3)ml和(1.5±0.6)ml,环切缝合器组手术时间较传统环切组缩短(P0.05),而加用弹力绷带后出血量减少(P0.05)。术后7d和14d,四组包皮水肿发生率差异无统计学意义(P0.05)。结论:在包皮环切缝合器术中使用自粘弹力绷带,可减少出血和血肿,并且不会加重包皮水肿,具有较好的临床效果和可行性。     

内板切除在包皮环切术中的应用及评价

目的探讨内板切除法在包皮环切术中的应用及疗效评价。方法对96例包皮过长患者采用内板切除法行包皮环切术;同期对108例患者采用传统手术方法,对两组术后出血、感染、系带水肿及阴茎外形满意度进行对比。结果两组术后出血均为2例（P〉O．05）两组术后均无感染发生。内板切除组术后发生2例系带水肿,而传统手术组术后22例系带水肿．两组的差异有统计学意义（P〈0．01）。内板切除组阴茎外形满意度96．9％,传统手术组为89．8％,两组的差异有统计学意义（P〈O．05）。结论内板切除应用于包皮环切术疗效理想,优于传统手术。     

HK型和Tara型两种包皮环套术的疗效评价

目的 探讨HK型和Tara型两种包皮环套术对包皮过长和包茎的治疗效果.方法 对本院2004年5月～2008年5月的200例HK型包皮环套术和200例Tara型包皮环套术患者的资料进行回顾性分析.结果 手术平均时间：HK犁环套术（8.21±0.54）min,Tara型环套术（10.23±0.67）min 术中出血量：HK型环套术（0.78±0.14）mL,Tara型环套术（0.32±0.11）mL 术后出血：HK环套术2例（1%）,Tara环套术0例 术后伤口感染和延迟愈合：HK环套术8例（4%）和Tara环套术3例（1.5%） 术后皮下线结和切口瘢痕形成：HK和Tara环套术均为0例.两种术式的手术时间、术中出血量差异有显著性（P〈0.05）,其他指标差异无显著性（P〉0.05）.结论 包皮环套术治疗成人和儿童包皮过长和包茎操作简便、出血少、副作用小,值得推广.伴有包皮严重粘连或尿道口病变的患者以开放手术为宜.     

包皮内外板定位法环切术60例疗效分析

目的:观察探讨包皮内外板定位法环切术治疗包皮过长、包茎伴或不伴蹼状阴茎的临床效果。方法:选取120例患者随机分为两组,60例观察组患者采用包皮内外板定位法环切术,60例对照组患者采用传统包皮环切术,观察两组患者治疗效果。结果:观察组患者术后切口均Ⅰ期愈合,切口瘢痕少,阴茎外形美观,观察组术中出血量为(20.0±8.9)ml、对照组术中出血量为(35.6±10.8)ml,两组差异显著(P<0.05)。观察组术后并发症发生率为1.67%,对照组为8.33%,前者低于后者,但两组差异不显著(P>0.05)。结论:包皮过长和包茎患者伴或不伴合并蹼状阴茎者采用包皮内外板定位法环切术治疗,阴茎美观,而且术中出血少,术后并发症少,较传统包皮环切术更有优势。     

Acquired phimosis after plastibell circumcision: a preventable consequence

INTRODUCTION

The plastibell device is used successfully for religious and cultural circumcisions in the community. The aim of this article is to highlight the recognition and management of iatrogenic phimosis.

METHODS

A retrospective study was performed of outcomes of plastibell circumcision in a community-based circumcision service provided by trained paediatric surgeons. The objective was to assess the complication of slipped plastibell rings and to ascertain the effectiveness of its management.

RESULTS

A total of 5 patients with a slipped plastibell ring were indentified out of 560 plastibell circumcisions. Three patients presented with acquired phimosis. In two patients early diagnosis and management prevented any further complications and a second operation was avoided.

CONCLUSIONS

Plastibell circumcision in the community is safe and effective. Detection of minor bleeding due to a slipped ring is important. Early management can avoid the risk of acquired phimosis due to cicatrix formation and can save parents of undue anxiety.     

传统包皮环切术和套环环切术在小儿包茎治疗中的比较分析

目的 比较分析传统包皮环切术和套环环切术在治疗小儿包茎中的利弊,为不同包茎患者选择环切术式提供参考.方法 对182例小儿包茎患者随机行包皮传统环切术或套环环切术,统计术前情况、手术时间和术后情况,对所有采集资料进行回顾性分析.结果 术前有粘连的小儿包茎患者术后愈合时间传统环切术[（9.14±2.71）d]较套环环切术[（13.01±3.12）d]更短（P＜0.05）,无粘连患者两种手术方式愈合时间差异无统计学意义（P＞0.05）;手术时间套环环切[（6±1.8）min]较传统环切[（15±2.5）min]明显缩短（P＜0.01）;术后伤口裂开渗血、粘连及水肿等并发症的发生率套环环切术较传统环切术更低（P＜0.05）;术后疼痛持续时间传统环切术较套环环切术更短（P＜0.05）.结论 两种手术方式均为小儿包茎患者的有效治疗方法,套环环切术因手术时间短、操作简单、术后并发症少和切口美观的优点可作为首选治疗方式,但术前有粘连的小儿包茎患者更推荐行传统环切术.     

The ultrasonic harmonic scalpel for circumcision: experimental evaluation using dogs

Male circumcision is one of the most commonly performed operations worldwide, and many novel techniques have been developed for better postoperative outcomes. The purpose of this study was to explore the feasibility of applying the ultracision harmonic scalpel (UHS) for circumcision by using dogs. Sixteen adult male dogs were divided into two groups: the UHS group and the control group. The dogs were circumcised with either the UHS or a conventional scalpel. The UHS circumcision procedure and the effects were imaged 1 week after surgery. The two groups were compared with respect to the operative time and volume of blood loss. Postoperative complications, including oedema, infection, bleeding of the incision and wound dehiscence, were recorded for both groups. The mean operative time for the UHS group was only 5.1 min compared with the 35.5 min of the conventional group. The mean blood loss was less than 2 ml for the UHS group and 15 ml for the conventional group. There was only one case of mild oedema in the UHS group, but the postoperative complications in the conventional group included two cases of mild oedema, one infection of the incision and one case of bleeding of the incision. In conclusion, circumcision using UHS is a novel technique to treat patients with phimosis and excessive foreskin, and this method has a short operative time, less blood loss and fewer complications than the conventional scalpel method. This small animal study provides a basis for embarking on a larger-scale clinical trial of the UHS.     

Surgical repair of traumatic amputation of the glans

Traumatic amputation of the penis in the pediatric population is rare. We present the case of a 4-year-old boy who, shortly after a plastibell circumcision, with the ring still in situ, experienced trauma to his glans, resulting in complete amputation. We describe our technique and outcome after surgical repair.     

切开挂线术治疗复杂肛瘘中的临床疗效观察

目的探讨切开挂线术治疗复杂肛瘘中的临床疗效。方法将60例复杂性肛瘘患者,随机分为两组,每组30例,分别标记为挂线组、结扎组。挂线组采用切开挂线术治疗,结扎组采用括约肌间瘘管结扎术治疗,比较两组术后疗效。结果挂线组愈合率为83．33％,结扎组愈合率为76．67％,差异无统计学意义（P〉0．05）。结扎组患者愈后肛门功能评分明显低于挂线组,差异有统计学意义（P〈0．05）。结论切开挂线术治疗复杂性肛瘘效果良好,能有效地保护了肛门括约肌的功能,提高患者的生活质量。     

微型腹腔镜下内环高位结扎联合包皮环套术治疗小儿腹股沟斜疝及包茎

目的:探讨微型腹腔镜下内环高位结扎联合包皮环套术治疗小儿腹股沟斜疝及包茎的可行性与优点。方法:对9例斜疝患儿先行微型腹腔镜下内环高位结扎术,随后对有包茎的患儿行包皮环套术。结果:患儿均顺利完成腹腔镜下内环高位结扎术和包皮环套术。术后恢复顺利,随访1-9个月,斜疝无复发。结论:微型腹腔镜下内环高位结扎术治疗小儿腹股沟斜疝较传统手术具有创伤小、美观、操作简便、手术时间短、并发症少、术后康复快等优点,联合包皮环套术术后容易清洗、护理,避免了二次手术和麻醉,减少了患儿的痛苦及治疗费用,是安全可行的。     

弹力线套扎吻合器治疗混合痔48例临床观察

目的探讨弹力线套扎吻合器治疗混合痔的临床疗效。方法将87例混合痔患者分成治疗组(48例)与对照组(39例),治疗组采用弹力线套扎吻合器治疗,对照组采用胶圈套扎吻合器治疗,观察两组的临床疗效、疼痛程度、愈合时间、术后出血、水肿、肛门狭窄等并发症。结果 1个月评价患者总体疗效后反映出,弹力线套扎吻合器治疗混合痔的治愈率为93.75%(45/48),采用胶圈套扎吻合器的治愈率为89.74%(35/39),两组患者总体疗效无明显统计学差异(P0.05)。而且两组有效率均为百分之百,但治疗组术后疼痛、术后水肿的积分和术后出血量、创面愈合时间均明显低于对照组(P0.05)。观察组有3例、对照组有4例出现中度肛门狭窄,经扩肛治疗后改善。结论弹力线套扎治疗优于胶圈套扎吻合器。     

混合痔外剥内扎术中痔蒂两种结扎方法临床效果比较

为了减少术后并发症,观察混合痔外剥内扎术中痔蒂两种结扎方法的临床治疗效果,对1048例混合痔患者采用10号丝线单纯结扎痔蒂（治疗1组）,1127例采用10号丝线缝扎和加固结扎痔蒂（治疗2组）。对两组创口愈合时间、结扎线脱落时间、创口感染率进行比较。结果显示,治疗1组结扎线脱落时间3～7d;创El愈合时间13～37d,平均17．4d;创口感染37例,占3．53％;原发性大出血2例,占0．19％;继发性大出血1例,占0．10％。治疗2组结扎线脱落时间3～22d;创口愈合时间16～53d,平均27．6d;创口感染57例,占5．06％;原发性大出血3例,占0．26％;继发性大出血11例,占0．98％。结果表明,在混合痔外剥内扎术中以10号丝线单纯结扎痔蒂是安全的、可靠的。可以减少创口感染的机会,结扎线脱落快而安全,可减少痔术后创口感染和痔术后继发性出血,缩短创口的愈合时间。     

Prior circumcision does not complicate repair of hypospadias with an intact prepuce

PURPOSE: Hypospadias concealed by an intact prepuce is a concern to practitioners performing newborn circumcision, especially given reports that foreskin removal may complicate urethroplasty. However, distal hypospadias repair today less often relies on skin flaps, and some patients may have circumcision interrupted for suspected urethral anomalies when none is present. We evaluated outcomes in consecutive males with hypospadias and an intact prepuce to compare results of urethroplasty in those with vs without prior circumcision. MATERIALS AND METHODS: A retrospective review of consecutive patients with hypospadias and an intact prepuce was performed. Patients circumcised before the urethral defect was recognized comprised group 1, while those presenting without circumcision comprised group 2. In all cases urethroplasty was accomplished by urethral plate tubularization without skin flaps, with coverage of the neourethra by a dartos flap. RESULTS: A total of 63 patients with hypospadias and an intact prepuce were operated on by one of us (WTS). Followup was at least 6 weeks for 36 of these patients, who comprised the study. There were no differences in age or followup among the 26 patients in group 1 compared to the 10 patients in group 2. The only complication was a fistula detected 4 years after surgery in a patient in group 1. CONCLUSIONS: Prior circumcision did not complicate subsequent hypospadias repair in males whose urethral anomaly was concealed by an intact prepuce. While circumcision should not be performed in newborns with obvious penile defects, it can be done in those with a normal foreskin without concern for the occasional discovery of hypospadias with an intact prepuce.