小儿阴茎显露不良的诊治进展

小儿阴茎显露不良是由先天性发育异常使阴茎体不能正常显露的一组症状群,而不是单纯的一种疾病。主要包括埋藏阴茎、隐匿阴茎、蹼状阴茎、陷没阴茎等。而由尿道下裂、两性畸形等引起的畸形小阴茎和由内分泌异常引起的小阴茎不属于该范畴。隐匿阴茎、埋藏阴茎和蹼状阴茎的病因和病理改变是先天性的,而陷没阴茎则是后天性原因引起。根据各自的病因病理改变和临床表现,诊断并不困难。根据它们不同的类型、年龄指征和病变程度选择相应的手术方式,会取得好的疗效。     

阴茎脱套固定术治疗儿童隐匿阴茎

目的:探讨用阴茎脱套固定术治疗小儿隐匿阴茎的效果。方法:对233例隐匿阴茎患儿采用阴茎脱套固定术治疗。将阴茎脱套至尿道球起始部水平,切断白膜表面纤维束带,将阴茎两上外侧的Scarpa筋膜连同Camper筋膜一起缝合固定于同侧阴茎根部白膜表面。结果:4例(1.7%)术后阴茎回缩,为手术缝合固定不当引起;包皮内板淋巴水肿1例。其余患儿随访4个月~4年,阴茎外观及显露满意,无蹼状结构;排尿及勃起正常。结论:采用的阴茎脱套固定术能够使这些病理改变得以纠正,适用于不同类型的隐匿阴茎,是一种较为理想的治疗选择。     

Correction of Retractile Concealed Penis

Several different mechanisms may account for the concealed appearance of the penis. A particular type of concealed penis is the retractile penis, due to dysgenetic fibrous bands tethering the penis to the prepubic subcutaneous tissue. The retractile nature of the concealment can be confirmed by flexion of the hips. A simple technique for surgical correction of the retractile penis is described. While there are many different methods to correct a concealed penis, proper selection of the technique based on understanding of the pathophysiology is critical to a successful outcome.     

脱套式阴茎固定术治疗隐匿阴茎(附200例报告)

目的：探讨脱套式阴茎固定术对200例隐匿阴茎患儿的治疗效果。方法：对200例隐匿阴茎患儿采用脱套式阴茎固定术,患者平均年龄6．5岁（3～12岁）。其中并发有包茎的患儿160例,明显肥胖者20例。结果：在平均约10个月的随访中,无明显肥胖者术后阴茎外形及发育良好。20例明显肥胖者中有4例术后2～3个月左右出现轻度阴茎回缩,其余阴茎外形良好,无复发。结论：脱套式阴茎固定术是治疗隐匿阴茎的理想术式,术后并发症少,外观满意。     

Tuberculid of the penis with a scab on the nodule

Tuberculids of the penis are extremely rare. The clinical features of tuberculids of the penis have been reported as ulceration or scars. We have experienced a case of tuberculid of the penis that appeared as a scab on nodule. A 56-year-old man presented with a 4-month history of a painless subcutaneous nodule at the glans penis. Pathological findings of the nodule showed granulomatous inflammation. Tuberculin tests were strongly positive, but tubercle bacilli could not be detected. The diagnosis was tuberculid of the penis and the patient received antituberculosis chemotherapy. The present paper reports an interesting and rare case of tuberculid of the penis with a scab on nodule.     

阴茎短小综合征的诊断与治疗

阴茎短小综合征(Small penis syndrome)是男性常见疾病,发病原因包括促性腺激素或性腺激素分泌障碍、雄激素不敏感等先天性因素,以及后天性疾病如阴茎硬结症、阴茎外伤、脊髓损伤等引起阴茎长度和粗细水平低于健康男性;另外,有些成年男性尽管阴茎大小达到平均水平,但是由于过度关注自身阴茎大小而引起长期焦虑、自卑和恐惧等心理障碍,甚至导致阴茎勃起功能障碍,影响性生活满意度,显著降低了生活质量,这种情况也属于阴茎短小综合征。近来,寻求治疗的阴茎短小综合征患者数目趋于增加。阴茎短小综合征在青春期前首先选择内分泌治疗,内分泌治疗无效者或青春期后的患者常需要手术治疗。本文论述了有关阴茎短小综合征的临床诊断与治疗方面的进展。     

Buried and trapped penis: a case report

While buried penis cases are characterised by congenital normal attachments to penis, trapped penis cases are characterised by insufficiency of penile skin occurring as a complication after surgical operations such as circumcision. Unless diagnosed, circumcision procedures should be avoided in congenital concealed penis cases. Here we present a case of congenital buried penis with deteriorated clinical findings after two circumcision procedures at 1.5 years of age. The surgical treatment applied in this case is discussed.     

尿道下裂成形术后阴茎阴囊外形缺陷的整复

目的:探讨对先天性尿道下裂成形术后阴茎阴囊外形缺陷的整形技巧。方法:对32例先天性尿道下裂成形术后因阴茎头形态缺陷、阴茎阴囊外形缺陷、阴茎皮肤丑陋瘢痕、阴茎勃起弯曲等进行以改善功能及美容为目的的整形手术、其中对阴茎囊轻度转位并阴茎短小矫正手术方法进行技术改进,并对手术病例分析总结。结果:经整形术后32例患者获得良好的功能改善和美容效果,无手术并发症。结论:所选用的几种针对性整形技术对尿道下裂成形术后阴茎阴囊形态不良再手术有良好的功能改善及美容效果。     

Evaluation and Treatment of Adult Concealed Penis

Concealed penis is a rare congenital disorder most commonly seen in children and the condition and surgical management have been well described. In contrast, there is a paucity of information with regards to adult concealed penis. Adult concealed penis may be due to trapping from skin contraction related to lichen sclerosis, cicatricial scars following surgical procedures, or prepubic adipose tissue causing poor phallic exposure. One of the greatest risk factors for concealed penis is obesity, and as this becomes a national pandemic, the incidence of adult concealed penis may increase. Therefore, a greater number of urologists may be faced with treating this difficult condition. This article reviews the etiology of adult concealed penis and describes the patient evaluation and various surgical approaches.     

经包皮内板切口阴茎延长增粗术的研究

目的探讨经包皮内板切口阴茎延长增粗术的方法。方法通过阴茎包皮内板切口进行阴茎浅悬韧带和部分深悬韧带的切断,以及真皮脂肪游离移植的阴茎延长增粗术。结果本组12例患者行包皮内板切口阴茎延长术,其中3例同时行阴茎增粗术,阴茎静态长度增加2.0~3.5cm,静态周径增加1.5~2.5cm,术区无血供障碍,感觉良好,效果满意。结论经包皮内板切口的阴茎延长增粗术用于包皮过长的患者可以获得更佳的手术效果,且切口隐蔽,避免了耻骨区的瘢痕形成。     

Successful surgical correction of true diphallia, scrotal duplication, and associated hypospadias

A 1-year-old child with complete duplication of penis presented with continuous dribbling of urine. Examination revealed hypospadias of 1 penis and a duplicated scrotum with 2 normal testes. Cystourethrogram revealed a single bladder with a normal urethra in the dorsally placed phallus and ectopic insertion into the bladder of the ventral urethra. Abnormality was corrected by excision of the ventrally located penis bearing the ectopic urethra. The preputial skin of this ventral penis was used to repair the hypospadias of the dorsal penis. The case is being reported in view of its rarity and the successful surgical correction.     

阴茎部整形术的应用解剖学研究

目的 探讨阴茎及其与邻近组织的解剖关系，为阴茎部整形术提供解剖学基础。方法 对30具(左右60侧)成年男性尸体的阴茎和会阴部进行解剖学观察，对阴茎各部的长度，漏斗韧带和悬韧带与阴茎根关系，阴茎海绵体脚与阴茎血管的关系进行观察和测量。结果 所测成人阴茎体长度为8．13cm；阴茎根长度为7．67cm，海绵体脚长度为5.96～5.98cm。漏斗韧带附着于阴茎根前部，阴茎浅筋膜两侧，并向下延伸为阴囊纵隔，参与组成阴囊和阴茎的悬吊结构；悬韧带附着于阴茎深筋膜背侧，后部增厚与耻骨弓状韧带紧密连结，参与尿道悬吊结构。在阴茎根部与阴茎海绵体脚部之间，有一段既无韧带附着又无骨性附着的海绵体，阴茎背动脉和神经在此处从腹侧转向背侧，阴茎背深静脉由此处穿过尿生殖膈注入盆腔内静脉丛。阴茎深动脉在海绵体脚骨性附着中部进入阴茎。结论 本组30例阴茎体长度的分区测量，阴茎悬吊结构的再认识及海绵体脚与阴茎深动脉的解剖关系对阴茎部整形手术具有重要意义。     

Construction of a neoclitoris in the surgery of male transsexuals

Summary To preserve the ability of male transsexuals who have been operated on to have orgasms, the glans penis and the corpus cavernosum urethrae are retained as a unit. The main vessels of the glans penis, the dorsal artery and vein of the penis running in the deep fascia of the penis are utilized as the neurovascular pedicle. The glans penis is placed into the anterior wall of the neovagina under the symphysis as the neoclitoris.     

正常成人阴茎及其毗邻组织结构的可视化研究

目的建立正常成人阴茎及其毗邻结构的数字化可视模型，为阴茎整形修复获得手术前后形变参数及手术方案的选择，提供形态学依据。方法采用第三军医大学解剖学教研室建立的数字化可视人体数据集（chinese visible human，CVH）部分连续图像，运用表面绘制的方法，对阴茎及其毗邻组织结构进行计算机三维重建和立体显示。结果可视化模型可清晰显示阴茎内部及毗邻结构的形态、分布特点和相互间的三维空间解剖关系。重建图像能单独或联合显示，并可进行任意径线和角度的适时三维测量。结论阴茎可视化模型能够准确反映出该区域复杂的解剖学特点及其内部空间毗邻关系，可为成人阴茎整形修复外科手术提供重要的形态学数据来源。     

A new method of surgical treatment of vasculogenic impotence

The authors describe a method of surgical management of vasculogenic impotence consisting in the formation of an anastomosis of an autovenous shunt with the dorsal artery of the penis. To prevent revascularization of the cavernous bodies of the penis with the restoration of erection, the dorsal artery of the penis is divided transversely at the root of the penis, the distal end of the autovenous shunt is given the shape of a trapezium with the upper side sutured, after which the autovenous shunt is anastomosed end to end with both the distal and proximal segments of the dorsal artery of the penis at the lateral sides of the trapezium where the angles were not sutured. The method allows incompetence and thrombosis of the vascular anastomosis to be prevented, raises the efficacy of revascularization of the cavernous bodies of the penis by creating favourable hemodynamic conditions through separation of the blood flow into the distal and proximal segments of the dorsal artery of the penis, which provides retrograde supply of blood into the deep artery of the penis sufficient for adequate revascularization of the cavernous bodies.     

单纯性隐匿阴茎诊断与改良Devine矫正术治疗体会

目的 探讨单纯性隐匿阴茎诊断方法,观察改良Devine矫正术治疗效果.方法 明确诊断为单纯性隐匿阴茎58例进行改良Devine矫正术.手术方法为冠状沟下方环形切开包皮,于阴茎深筋膜浅层向阴茎根部游离脱套,充分切除阴茎体与皮肤之间发育不良的肉膜组织以及纤维索带.充分伸直阴茎,于阴茎皮肤与会阴皮肤延续处,2、10点分别切取5mm切口,通过此切口固定阴茎白膜与阴茎皮肤真皮层.结果 平均手术时间40min,术后平均住院时间4～4.5d.所有患者术后阴茎显露较术前改善明显,较术前阴茎外形延长2.0～2.5cm;加压包扎3～4d,有不同程度包皮水肿,以内板水肿明显,于术后2～4周消退.伤口边缘皮肤坏死1例,清创换药两周后愈合.结论 诊断隐匿性阴茎从严掌握标准,充分的阴茎皮肤脱套松解、切除异常组织以及阴茎根部白膜固定为手术治疗的关键.采用Devine矫正术,结合阴茎根部两点直视下固定,具有手术操作简单、固定点明确可靠、创伤小、外观满意的特点,是治疗单纯性隐匿阴茎的有效术式.     

隐匿阴茎212例诊治分析

目的探讨隐匿阴茎的最佳手术方法。方法总结212例隐匿阴茎诊断和治疗的经验,介绍三点式阴茎固定术、改良的Devine术和改良的阴茎脱套固定术的手术方法与指征。结果三点式阴茎固定术64例术后3个月龟头显露,阴茎回缩,外观短小。改良的Devine术68例,术后阴茎显著外露,阴茎较术前延长2～3cm。改良的阴茎脱套固定术80例,术后阴茎显著外露,阴茎较术前延长3～4cm,阴茎外形矫正良好。三种术式术后阴茎勃起功能均正常。结论隐匿阴茎手术方法应根据患者的年龄、病理特点和严重程度设计,重度或完全型隐匿阴茎行改良的阴茎脱套固定术为宜,该术式方法简单,术后阴茎外观好。     

Rupture of the superficial dorsal vein of the penis

Unusual causes of acute penis, such as the rupture of a superficial vein of the penis, can mimic fractured penis. The diagnosis in such cases is mostly after exploration. The author describes a case where a high index of clinical suspicion led to the diagnosis of the rupture of a superficial dorsal vein of the penis without exploration. The patient had a successful recovery with conservative management.     

Hidden penis release: adjunctive suprapubic lipectomy

We believe the hidden penis may be caused and concealed by a prominent suprapubic fat pad in addition to the restrictive fibrous bands of the dartos fascia fixing the shaft of the penis proximally while loose skin folds prolapse distally over the phallus. A penis of inadequate length or appearance may affect body image. Patients with this problem often require psychological support. Hidden penis may be distinguished from micropenis by palpating adequate corpora and showing a stretched penile length within 2 SD of normal. Excision of suprapubic fat with sectioning of the tethering dartos bands will release and increase the length of the penis. Suprapubic fat pad resection may also be helpful to elongate a short penis in cases of adult microphallus, or after partial penectomy because of trauma or cancer. Circumcision is contraindicated.     

经阴茎腹侧阴茎周围组织环形松解、白膜固定包皮整形术治疗小儿埋藏阴茎

目的:探寻治疗小儿埋藏阴茎的简单、有效手术方法。方法:根据埋藏阴茎的临床特点,设计一种新的手术方式即经阴茎腹侧阴茎周围组织环形松解、白膜固定包皮整形术:阴茎根部腹侧"V"形切口,环形松解阴茎浅、深筋膜及异常附着的肉膜肌、纤维索带,阴茎根部左、右侧白膜分别与胸膝位耻骨结节前筋膜的1、11点各缝合固定1针进行手术,共治疗小儿埋藏阴茎38例,术后随访2~6个月。结果:38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35例(92.1%)阴茎外观形态满意,2例仍有阴茎轻度埋藏,1例出现包皮口瘢痕狭窄。结论:采用经阴茎腹侧阴茎周围组织环形松解、白膜固定包皮整形术治疗小儿埋藏阴茎是一简单、有效的手术方法,具有推广应用价值,但仍需积累更多的病例和更长时间的随访。