传统包皮环切术与吻合器治疗儿童包茎、包皮 过长的临床效果比较研究

目的 探讨传统包皮环切术与一次性环切吻合器治疗包茎和包皮过长患儿的手术效果及并发症的发生率。方法 回顾性分析云南省妇幼保健院小儿外科2021年1月至2023年1月收治的261例包茎和包皮过长的患儿，采用传统方法包皮环切术129例（对照组）和使用一次性环切吻合器132例（试验组）进行治疗，观察两组在术中指标（手术时间、术中出血量）、术后相关指标（术后疼痛程度、术后切口愈合时间、切缘重度水肿、切口裂开、术后再次出血、术后感染、外观满意度）等方面进行对比。结果 试验组手术时间、术中出血量、术后再次出血指标均明显少于对照组，而对照组在术后切口愈合时间、切缘重度水肿发生率较试验组有明显优势，两组在术后疼痛程度、术后感染率、切口裂开及外观满意度方面差异无统计学意义（P<0.05）。结论 两种方法治疗儿童包茎和包皮过长，传统的包皮环切术的优势在于术后恢复相对快、切缘水肿程度轻；一次性环切吻合器优点在于止血彻底、操作简便易行且安全，适合基层医疗使用，但在术后恢复方面不如传统方法。治疗方案各有优势，方式选择应需要根据患儿的实际情况，多进行个体化治疗，以达到最好的治疗效果。

Clinical analysis of traditional surgery and circumcision stapler in the treatment of children with phimosis and prepuce

Objective To investigate the surgical effect and incidence of complications of traditional circumcision and disposable circumcision stapler in the treatment of phimosis and overlength of prepuce. Methods A retrospective analysis of 261 children with excessive phimosis and prepuce treated in the Department of Pediatric Surgery of our hospital from January 2021 to January 2023. The control group included 129 cases, who were treated by traditional methods, and the others 132 cases as test group, were treated by disposable circumferential stapler. We observed correlation indicators of intraoperative and postoperative between the two groups. Operation time, intraoperative blood loss were intraoperative indicators, and, postoperative pain degree, postoperative incision healing time, severe edema of incision margin, incision dehiscence, postoperative rebleeding, postoperative infection, and appearance satisfaction were observed in the postoperation period. Results The operation time, intraoperative blood loss, and postoperative rebleeding of the disposable circumferential stapler group were significantly less than those of the control group, while the postoperative incision healing time and the incidence of severe edema of the incision in the control group had obvious advantages compared with the test group. There was no significant difference in pain degree, postoperative infection rate, incision dehiscence and appearance satisfaction. Conclusions The benefits of traditional circumcision are that postoperative recovery is relatively fast and the degree of edema at the incision margin is mild. And complete hemostasis, surgical operation easily, safety, and suitable for subordinate medical institutions are advantages of disposable circumcision stapler compare with traditional model, meanwhile it is not as good as traditional methods in terms of postoperative recovery.