改良阴茎成形术治疗重度隐匿阴茎(附42例报告)

目的介绍使用改良Shiraki术联合"V"形切口治疗42例重度隐匿阴茎的方法和效果。方法自2011年8月至2013年8月间本院对42例重度隐匿阴茎患儿采取改良Shiraki联合"V"形切口术,此改良阴茎成形术分3个主要步骤:首先分别在外板的12点处及包皮内板的3点、9点处纵向切开,阴茎皮肤脱套至阴茎根部,同时切除阴茎体外层纤维索带,充分松解阴茎体使其完全伸展;修剪重建包皮系带伸直阴茎头,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;最后取阴茎腹侧V形切口,阴茎腹侧延长,重建阴茎阴囊角。结果手术时间约40~55 min,随访12~24个月,40例阴茎发育及外观效果满意,2例较肥胖的患者术后阴茎体显露效果不佳。13例包皮内板水肿患者术后12周内均基本消退。结论该术式操作相对简单,损伤小,外观良好,并发症少,我们认为是治疗重度隐匿阴茎比较理想的手术方式之一。

Use of modified phalloplasty in treating severe concealed penis (report of 42 cases

Objetive To determine the effectiveness of modified Shiraki method associated with V-shaped incision as a new surgical treatment method for severe concealed penis. Methods From August 2011 to August 2013,42 patients with severe concealed penis underwent the modified Shiraki method associated with V-shaped incision.The technique consists of 3 steps:1)First is Longitudinal cutting at 3′,9′of inner prepuce and 12′of outer prepuce,the seperation of inner and outer prepuce,skin degloving,resection of fibrous tissue and mobilization of divergent corpus spongiosum;2)transection and longitudinal suture at the frenulum to elon-gate inner ventral prepuce,excise redundant inner prepuce flap,while outer prepuce is preserve as much as pos-sible,with embedding sutures of inner and outer prepuce;3)At last,through V — shaped incision for the ventral side of the penis,penile ventral extension,reconstruction of penis and scrotum angle. Results The operative time ranged from 40 min to 55 min.The follow-up period was for between 12 ~24 months.The appearance of penis was satisfactory in 40 patients.2 patient had sub-optimal result because of underlying obesity.13 cases with inner prepuce edema had good recovery within 12 weeks after operations. Conclusions Modified Shiraki method associated with V-shaped incision has the advantages of less complication,simple operation and satisfac-tory appearance.It should be recommended as an ideal operation to treat severe concealed penis.