改良Devine 术与传统Shiraki 治疗小儿隐匿性阴茎的临床探讨

白剑+高卫华+梁劲文+梁萍宝+梁裕柱+卢丹丹+钟小华

[摘要] 目的 探讨改良Devine 术治疗小儿隐匿性阴茎的可行性及优势。 方法 选取2013年1月～2015年12月我院120例小儿隐匿性阴茎的患儿，采用前瞻性随机平行对照临床试验的研究方法。实验组采用改良Devine 术，对照组采用传统Shiraki术。分别于手术前后观察阴茎显露长度、外观效果以及有无并发症。 结果 两组患儿均顺利手术，无血管、神经、尿道损伤。采用改良Devine 术治疗小儿隐匿性阴茎，术后阴茎自然显露长度较术前延长（2.20±0.52）cm，较术前明显改善（P<0.01），包皮肿胀无或轻度；采用传统Shiraki术治疗小儿隐匿性阴茎，术后阴茎自然显露长度较术前延长（1.00±0.26）cm，术后5例有包皮内板肿胀形成皮赘，1例二次手术整形。 结论 采用改良Devine 术（包皮脱套松解阴茎延长固定术）治疗小儿隐匿性阴茎，术后阴茎自然显露满意，效果好，无明显术后并发症，是一种治疗隐匿性阴茎的理想术式。

[关键词] 改良Devine；传统Shiraki；小儿隐匿性阴茎；并发症

[中图分类号] R726.9 [文献标识码] B [文章编号] 1673-9701（2016）23-0065-03

[Abstract] Objective To explore the feasibility and advantages of modified Devine surgery in the treatment of pediatric concealed penis. Methods 120 children patients with pediatric concealed penis who were admitted to our hospital from January 2013 to December 2015 were selected. The research method of prospective randomized paralleled controlled clinical trial was applied. The experiment group was given modified Devine surgery， and the control group was given traditional Shiraki surgery. The revealed penis length， appearance and postoperative complications were observed before and after the surgery. Results The surgery was successful in the two groups， without vascular， neural and urinary tract injuries. Modified Devine surgery was applied in the treatment of pediatric concealed penis. The natural revealed length of the penis after the surgery was （2.20±0.52） cm longer than that before the surgery， which was significantly improved before the surgery（P<0.01）. There was no swelling foreskin or slight swelling； traditional Shiraki surgery was applied in the treatment of pediatric concealed penis. The natural revealed length of the penis after the surgery was（1.00±0.26） cm longer than that before the surgery. There were 5 cases of swelling inner plate of foreskin forming into skin tag， and 1 case of second surgery for form correction. Conclusion Application of modified Devine surgery（foreskin degloving and debonding penis extension and fixation surgery） in the treatment of pediatric concealed penis has satisfactory natural revealing of penis， favorable effects and no significant complications after the surgery， which is an ideal surgical approach for the treatment of concealed penis.

[Key words] Modified Devine surgery； Traditional Shiraki surgery； Pediatric； Concealed penis； Complication

隐匿性阴茎（concealed penics，CP）是一种小儿泌尿生殖系统的常见疾病，表现为阴茎体发育正常而显露异常，多见于学龄前期儿童，在阴茎畸形疾病中发病率为0.67%，仅次于包茎和包皮过长[1]。临床特征是阴茎外形异常，包皮似鸟嘴状包裹阴茎，与阴茎体不附着，背侧包皮短，腹侧包皮长，内板多，外板少，但阴茎海绵体发育正常[2-3]。解剖隐匿性阴茎，发现阴茎内膜大部分被条索状组织取代，弹性较差，阴茎肉膜与Bucks筋膜不能附着，阴茎伸缩受限制，大部分阴茎体固定于耻骨联合下方[4]。隐匿性阴茎可引起尿道外口和包皮龟头炎，患儿容易产生自卑心理。近年来，随着对病因的进一步认识，出现了Shiraki 术、Devine术等术式，但仍有术后阴茎外露不满意、外形不美观等各种缺点。我们在Devine 术式基础上加予改良，称之为“包皮脱套松解阴茎延长固定术”，更好地解除阴茎病理性牵拉，阴茎外形较术前延长（2.20±0.52）cm，术后包皮肿胀无或轻度，深得患儿家长满意。……