小儿塑料套环包皮环切术1 000例报告

目的总结塑料套环包皮环切术治疗小儿包茎的经验。方法对1994～2004年行塑料套环包皮环切术治疗小儿包茎1000例进行回顾性分析。结果1000例小儿塑料套环包皮环切术术后效果良好。套环脱落时间最长13d，最短8d，平均9．5d。脱落后切缘整齐，外形美观。并发包皮感染3例，套环脱落4例，包皮撕裂3例，包皮环嵌入冠状沟2例，阴茎头出血1例，尿潴留1例。结论小儿塑料套环包皮环切术具有手术时间短，不出血或出血极少，组织创伤小，并发症少，患儿痛苦小，切缘整齐美观，术后护理方便，手术简单易于推广等优点。     

小儿包皮环套术与环切术的临床分析

目的探讨小儿包皮过长、包茎的手术较佳方式。方法对1997年至2005年826例(随机分为环套术631例、环切术195例)小儿包茎、包皮过长进行回顾性分析,采用x2检验。结果手术时间分别为(4±1)min和(20±5)min(P<0．01);总并发症发生率分别为5．23％(33／631)和18．97％(37／195)(P< 0．01);术后护理工作量:环套术组明显简单于环切术组。结论小儿包皮过长、包茎以包皮环套术为优。     

包皮环套术治疗包茎及包皮过长311例体会

目的探讨包皮环套术治疗包皮过长、包茎的方法。方法 2010年1月至2010年12月采用一次性包皮环切吻合器行包皮环套扎术治疗311例,观察手术疗效。结果手术成功306,成功率为98.4%,平均手术时间7 min,包皮内板撕裂3例,失败2例,切口裂开3例,术后随访1～3个月,切口愈合光滑、平整,恢复良好。结论包皮环套术治疗包茎、包皮过长是一种操作较简易、痛苦小、安全性高、疗效好的理想方法。     

成人包皮环套术中结扎强度与相关并发症的关系

目的：探讨成人包皮环套术后包皮水肿和内外板分离的主要病阂。方法：选择300例门诊患者,予以前瞻、对照性研究。随机分两组,一组为强结扎作用（弹力线＋大套环）,一组为弱结扎作用（普通丝线＋小套环）,观察两组术后包皮水肿和内外板分离的发生率。结果：强结扎作用组出现72例中度以上包皮水肿,17例内外板分离,弱结扎作用组出现37例中度以上包皮水肿,5例内外板分离,前组发病率高于后组,差别均有显著性意义。结论：结扎作用过强是导致成人包皮环套术后皮水肿和内外板分离的主要病因。控制好两个作用力结扎线弹力和套环张力,为伤口创造一个良好的张力环境是降低术后上述两个并发症的关键。     

Outcome assessment of office Plastibell circumcision in infants utilizing interactive electronic health record

ObjectiveTo assess the outcomes of office-based circumcision performed using Plastibell devices in infants, utilizing the MyChart interactive electronic health record (iEHR) system to monitor the progress and identify potential complications.MethodsThis is a prospective cohort study conducted between March 2021 to April 2022 on all infants undergoing office based Plastibell circumcision. Parents were encouraged to submit concerns via MyChart and to submit photos if the ring has not fallen by post-procedure day 7. Telehealth or in-person clinic visits were then made accordingly. Postoperative complications were collected and compared with existing literature.ResultsOf the 234 consecutive infants, the average age was 33 days (9–126 days) and the average weight was 4.35 kg (2.5–7.25 kg). A total of 170 parents (73%) responded to MyChart messages. Fourteen (6%) complications necessitating local intervention were identified: excessive fussiness (1), bleeding (2), ring retention (11) including 2 incomplete skin division requiring repeat dorsal block and surgical completion, fibrinous adhesion (3), and proximal ring migration (6). The photo and messages submitted through iEHR facilitated early patient return for intervention. Additionally, 17 parents submitted photos which were expected postprocedural findings and were reassured through iEHR, thus omitting unnecessary return visits. The 2 patients with incomplete skin division occurred early in the series using the included cotton ties. Subsequent procedures were performed with double 0-Silk ties (n = 218) without similar finding.ConclusionThe interactive utilization of iEHR communication in the post-circumcision period identified proximal bell migration and bell trapping, allowed earlier intervention and reduced complications.Level of EvidenceLevel 1.     

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.     

局部浸润麻醉在小儿包皮环扎术中的应用

目的：探讨局部浸润麻醉在小儿包皮环扎术中的应用方法与效果。方法在小儿包皮环扎术中采用1%的利多卡因作包皮远端局部浸润麻醉,观察总结麻醉及手术效果。结果所有患儿均顺利完成手术,麻醉效果满意,麻醉药物用量1.5～2 mL,无1例患者因疼痛明显需追加其他麻醉方法。结论小儿包茎及包皮过长行包皮环扎术适合采用局部浸润麻醉。