改良Shiraki手术治疗隐匿性阴茎

目的 探讨改良Shiraki手术方法在隐匿性阴茎手术中的意义.方法 自2005年5月至2009年12月间对53例隐匿性阴茎患儿采用改良Shiraki手术进行治疗,其主要手术步骤是:①分别在包皮内板的3点、9点处及外板的6点、12点处纵向切开;②内板与外板分离,在阴茎白膜外层行阴茎皮肤脱套至阴茎根部,同时切除阴茎体外层纤维索带,充分松解阴茎使其完全伸展;③包皮系带横切纵缝成形使包皮内板腹侧延长;④剔除内板皮下水肿的筋膜组织,修剪过宽包皮内板皮瓣,外板尽量保留,然后内外板皮瓣嵌插缝合;⑤置Folay导尿管,用网眼纱布均匀包扎阴茎.结果 术后随访18至24个月,阴茎显露明显改善,较术前延长2～4 cm,阴茎皮肤无坏死.阴茎外形均满意,3例术后阴茎皮肤水肿,3个月后消退,此3例为初期病例;随访1年以上者阴茎肿胀基本消失.结论 采用改良Shiraki手术方法进行包皮延长成形术矫正隐匿性阴茎可获得满意的效果,与Shiraki术式相比其有如下优点:①手术操作简化,易掌握并缩短了手术时间;②皮瓣血供好,切口愈合佳,减少了皮瓣坏死的机会;另外对皮瓣淋巴回流阻断明显减轻,术后阴茎皮肤肿胀情况不明显;③不进行阴茎体固定仍可获得满意的效果,并且避免了阴茎背侧血管神经及尿道的损伤.     

“V”形切口改良Brisson手术治疗小儿隐匿阴茎

目的 介绍使用“V”形切口改良Brisson手术治疗隐匿性阴茎34例的方法和效果.方法 手术通过用阴茎腹侧“V”形切口改良Brisson术来完成,松解阴茎伸展外露后,修剪包皮系带伸直阴茎头,对合缝合包皮,从阴茎腹侧V形切口,去除发育不良的筋膜组织,在阴茎腹侧根部将皮下筋膜层与尿道前筋膜缝合固定.结果 手术时间约40～60 min,随访6～12个月,阴茎发育及外观效果满意,1例较肥胖的患儿术后显露效果不佳.3例水肿患儿术后2周内均基本消退.结论 本术式相对简单损伤小,外观良好,我们认为是治疗隐匿性阴茎比较理想的手术方式之一.     

儿童隐匿阴茎分型诊疗的临床探讨

目的 探讨小儿隐匿阴茎的分型及治疗.方法 对我院2009年12月至2013年12月收集的83例小儿隐匿阴茎患儿的临床资料进行回顾性分析,根据包皮口夹角角度对其进行分型,隐匿阴茎Ⅰ型:包皮口夹角为30°～45°,隐匿阴茎Ⅱ型:包皮口夹角为46°～90°,隐匿阴茎Ⅲ型:包皮口夹角为大于90°,其中,Ⅰ型隐匿阴茎3例,Ⅱ型10例,Ⅲ型70例.隐匿阴茎Ⅰ型和Ⅱ型采用改良Brisson术,隐匿阴茎Ⅲ型采用改良Shiraki术,根据Boemers标准评价术后效果,术后总体效果可分为良好、一般和不良.结果 术后5～6 d去除敷料暴露伤口并拔除尿管,术后6～7 d出院.所有病例均获得随访6个月至2年,平均12个月,12例有包皮内板轻度水肿,随访6～12周后均恢复正常;81例阴茎体显露良好,家长对阴茎外观满意,2例阴茎体显露一般.结论 通过不同手术方法治疗不同分型的儿童隐匿阴茎,针对性强,阴茎外观良好,并发症相对较少.     

儿童隐匿型阴茎45例诊治分析

2002年5月￣2006年1月我院应用改良Devine术治疗隐匿阴茎患儿45例,均取到满意疗效,现报告如下。1临床资料1.1一般资料本组45例,平均年龄8岁6个月(3～12岁),病例纳入标准为:①阴茎外观短小;②用手向后推挤阴茎根部的皮肤见有正常阴茎体显露,松开后阴茎体迅速回缩;③隐匿在皮下的是发育正常的阴茎体;④除外其他伴发的阴茎畸形,如尿道下裂、特发性小阴茎、包皮环切术不当或外伤引起的瘢痕束缚阴茎等;⑤除外肥胖婴幼儿阴茎体部分埋藏于耻骨前脂肪堆中。1.2手术方法采取背侧低腹侧高的斜形环形切口(用直血管钳固定),切开内外板皮肤,沿Buck's筋膜…     

经阴茎腹侧松解固定术治疗小儿隐匿阴茎

目的探讨治疗小儿隐匿阴茎的简单、有效的手术方法。方法采取经阴茎腹侧松解固定术治疗小儿隐匿阴茎28例,术中经阴茎腹侧,松解阴茎体周围的异常附着组织,将阴茎根部白膜固定于耻骨前筋膜和腹侧阴囊皮下筋膜层,重新建立阴茎耻骨角和阴茎阴囊角,于包皮内外板交界处环形切开,松解狭窄环,缝合包皮覆盖阴茎体。术后随访6～36个月。结果28例出院时阴茎外观形态均满意,阴茎体完全显露。术后随访期间无复发,阴茎水肿均于术后3周至半年内消退。结论采用经阴茎腹侧松解固定术治疗小儿隐匿阴茎简单有效,具有良好的美容效果,值得临床推广。     

Sugita法治疗重度隐匿阴茎

隐匿阴茎是一种较常见的先天性阴茎发育畸形,临床表现为阴茎外观短小,皮肤表面仅见包皮堆积,扪不到阴茎体,用手向后推挤阴茎根部皮肤可以显露正常长度阴茎体,松开后阴茎体迅速回缩.对于该病的手术治疗主要包括包皮脱套至阴茎根部、松解异常索带,重建阴茎耻骨和阴茎阴囊角,采用不同部位的皮肤进行覆盖缺损的包皮外板[1].其中包皮外板的覆盖并有良好的术后外观常常是手术的关键.     

Sugita法治疗重度隐匿阴茎

隐匿阴茎是一种较常见的先天性阴茎发育畸形,临床表现为阴茎外观短小,皮肤表面仅见包皮堆积,扪不到阴茎体,用手向后推挤阴茎根部皮肤可以显露正常长度阴茎体,松开后阴茎体迅速回缩.对于该病的手术治疗主要包括包皮脱套至阴茎根部、松解异常索带,重建阴茎耻骨和阴茎阴囊角,采用不同部位的皮肤进行覆盖缺损的包皮外板[1].其中包皮外板的覆盖并有良好的术后外观常常是手术的关键.     

Sugita法治疗重度隐匿阴茎

隐匿阴茎是一种较常见的先天性阴茎发育畸形,临床表现为阴茎外观短小,皮肤表面仅见包皮堆积,扪不到阴茎体,用手向后推挤阴茎根部皮肤可以显露正常长度阴茎体,松开后阴茎体迅速回缩.对于该病的手术治疗主要包括包皮脱套至阴茎根部、松解异常索带,重建阴茎耻骨和阴茎阴囊角,采用不同部位的皮肤进行覆盖缺损的包皮外板[1].其中包皮外板的覆盖并有良好的术后外观常常是手术的关键.     

经阴茎根部腹侧阴茎阴囊整形术治疗先天性隐匿阴茎

目的 探讨经阴茎根部腹侧入路的阴茎阴囊整形术治疗先天性隐匿阴茎的临床疗效.方法 针对本病的包茎、阴茎皮肤缺乏、阴茎周围肉膜肌的异常附着、特别是阴茎阴囊交界处皮肤的蹼状改变等,采用不但可使阴茎阴囊蹼状改变得到整形,也利于阴茎的充分松解和固定,还可达到延长阴茎皮肤目的的楔形皮肤切口.同时还采用包皮口横切后外板纵形剪开,背侧楔形切除多余内板的的方法,不但解除了包茎,也避免了过多的内板使用.结果 近10年间用此术式治疗先天性隐匿阴茎359例,年龄最小3岁,最大14岁,其中5～7岁224例(62.4％).术后获半年以上随访者265例(73.8％),其中阴茎显露良好,无退缩现象、无包茎、阴囊皮肤无臃肿现象、切口无瘢痕形成和排尿通畅者共247例(93.2％).术后早期出现阴囊血肿7例.远期并发症包括:腹侧切口瘢痕形成3例,后经瘢痕切除治愈.包皮口出现瘢痕环形狭窄并影响阴茎头外露5例,门诊经瘢痕切除治愈.外观仍显阴茎短小10例(4.6％),但经外用睾酮霜2个月后外观明显改善毋需进一步治疗.结论 结果显示此方法简单,效果显著,且并发症多可预防,是一种治疗先天性隐匿阴茎的好术式.     

儿童隐匿阴茎手术治疗82例

目的：探讨手术治疗儿童隐匿阴茎的疗效。方法回顾性分析2009年1月至2011年12月在本院接受手术治疗的82例隐匿阴茎患儿临床资料。术前检查显示阴茎外观短小,严重者仅见包皮堆而无阴茎体显露,用拇指和食指将阴茎周围皮肤后推可显露发育及长度基本正常的阴茎体,松手后阴茎体迅速回缩。患儿均有包皮口狭窄,阴茎头不外露。手术操作包括：松解包皮狭窄环、脱套阴茎皮肤、转移阴囊皮肤增加阴茎体皮肤覆盖、固定海绵体白膜和阴茎根部皮下组织,重建阴茎阴囊角。结果82例均获随访,平均手术年龄为5（1～13）岁,平均手术时间为40（30～70）min,平均随访时间为6（3～24）个月。术后阴茎体显露良好,阴茎体无明显回缩。结论手术可有效矫正隐匿阴茎外观,改善阴茎体显露。     

Surgical correction of congenital megaprepuce

Congenital megaprepuce (CMP) is a rare entity. Two infant boys presented with a tight congenital phimosis resulting in an excessively baggy, urine-filled prepuce and a swollen scrotum. Compression of the scrotum resulted in drainage of urine. We feel this to be a separate entity from a buried penis and recommend early surgery. The phimotic tip of the foreskin was excised and the inner layer preserved to cover the full length of the penile shaft. The outer layer of the foreskin, in reality the penoscrotal junction, was anchored to the base of the penile shaft. A V-shaped edge of ventral skin was excised and the edges approximated, giving the appearance of median raphe. The final appearance was that of a circumcised penis. A third patient awaits operation. Accepted: 25 November 1998     

小儿埋藏性阴茎的诊断与外科治疗

为了探讨埋藏阴茎的最佳的手术治疗方法，对近１２年中收治的年龄４～１３岁８５例患儿，应用包括包皮外板多处小切口纵切横缝包茎、耻骨联合前上方皮下组织切除、阴茎筋膜分离和阴茎根部皮肤与耻骨骨膜缝合的方法进行手术。术后半年以上获得随访共６７例，其中效果满意５９例（８８．１％），尚有轻度阴茎埋藏８例（１１．９％）。提示本术式是治疗埋藏阴茎简单有效的方法。     

渐进性皮瓣转移技术治疗先天性隐匿阴茎

目的 通过总结103例先天性隐匿阴茎的临床资料,探讨渐进性皮瓣转移技术应用于先天性隐匿阴茎的诊治经验.方法 2006年7月至2008年9月,采用渐进性皮瓣转移技术治疗先天性隐匿阴茎患儿103例,年龄为6个月至12.3岁,所有病例均符合先天性隐匿阴茎的诊断,其中3例伴有明显肥胖.结果平均随访1.5年(6个月至2.5年).所有患儿阴茎外观均较满意,阴茎显露好,无包皮臃肿现象.术后1例冈阴茎根部皮肤附着不佳仍有同缩,2例患儿在阴茎根部切口处轻度裂开.结论 渐进性皮瓣转移技术治疗先天性隐匿阴茎,术后阴茎外观接近包茎术后表现,术后再回缩等并发症少.渐进性皮瓣转移技术可以作为治疗先天性隐匿阴茎的常规术式.     

Sugita手术治疗小儿先天性隐匿阴茎

目的 观察Sugita术式治疗小儿先天性隐匿阴茎的疗效.方法 对我院2008年1月至2010年12月采用Sugita方法治疗的78例中重度小儿隐匿阴茎患儿的临床资料进行回顾性分析,总结该方法的手术疗效.结果 术后4～5 d去除敷料暴露伤口,拔除尿管,术后5～6 d出院.所有病例均获得随访6个月至3年,平均6.5个月,均排尿正常;8例有包皮内板轻度水肿,其中5例术后6～8周恢复正常,3例术后10～12周恢复正常;74例阴茎体显露良好,家属对阴茎外观满意,4例家属认为阴茎短小.结论 Sugita手术治疗小儿先天性隐匿阴茎设计合理,操作简单,美容效果良好,并发症相对较少,是治疗小儿先天性隐匿阴茎的较好方法.     

The extended Mathieu procedure in coronal,distal penile,and midshaft hypospadias repair

The Mathieu procedure was adequately modified for glanular, coronal, and midshaft hypospadias variants with chordee and/or urethral hypoplasia in order to anatomically reconstruct the penis. A total of 129 patients aged 12 months to 22 years with coronal (35.7%), distal penile (51.9%), and midshaft (12.4%) hypospadias were operated upon. Chordee was found in 33.3% and distal urethral hypoplasia in 15.5% of the patients. The ventral flap was based anatomically on the external meatus, the glans was made pyramidal with an apical external meatus, the prepuce was resutured, and the neurethra was buried deeply within the glans. In patients with distal urethral hypoplasia the external meatus was incised proximally; in chordee the urethral plate was mobilized off the corpora cavernosa. Fistulas were uncommon (3.4%) in the primarily operated patients. The external meatus was always apical, and no stenosis was demonstrated at follow-up. The prepuce was reconstructed in 71.5% of patients. The extended Mathieu procedure appears recommendable for all coronal, distal penile, and midshaft variants regardless of associated anomalies of the penis. It also seems suitable for secondary repairs. The prepuce can be reconstructed in the majority of patients. The complication rate is significantly low compared to other methods, and the extended Mathieu operation is a good teaching tool with a high success rate and versatility.     

Concealed penis

A small phallus causes great concern regarding genital adequacy. A concealed penis, although of normal size, appears small either because it is buried in prepubic tissues, enclosed in scrotal tissue penis palmatus (PP), or trapped due to phimosis or a scar following circumcision or trauma. From July 1978 to January 2001 we operated upon 92 boys with concealed penises; 49 had buried penises (BP), while PP of varying degrees was noted in 14. Of 29 patients with a trapped penis, phimosis was noted in 9, post-circumcision cicatrix (PCC) in 17, radical circumcision in 2, and posttraumatic scarring in 1. The BP was corrected at 2-3 years of age by incising the inner prepuce circumferentially, degloving the penis to the penopubic junction, dividing dysgenetic bands, and suturing the dermis of the penopubic skin to Buck's fascia with nonabsorbable sutures. Patients with PP required displacement of the scrotum in addition to correction of the BP. Phimosis was treated by circumcision. Patients with a PCC were recircumcised carefully, preserving normal skin, but Z-plasties and Byars flaps were often required for skin coverage. After radical circumcision and trauma, vascularized flaps were raised to cover the defect. Satisfactory results were obtained in all cases although 2 patients with BP required a second operation. The operation required to correct a concealed penis has to be tailored to its etiology.