改良Shiraki術治療隱匿性陰莖26例報告

劉長華 吳宏飛 華立新

[摘要] 目的 提高隱匿性陰莖的診治水平。方法 采用Shiraki術為基本術式,同時切除影響陰莖伸出的附著于陰莖海綿體上的纖維索帶,陰莖根部皮膚固定于白膜上。手術后5例患兒輔以人絨毛膜促性腺激素(HCG)治療。結果 26例患兒切口均一期愈合,術后隨訪3個月-5年,陰莖外觀滿意,陰莖勃起時無障礙25例(96.2%)。1例(10歲)患者,術后雖予HCG治療,陰莖仍未能達到正常形態。結論 改良Shiraki術治療隱匿性陰莖效果滿意。

[關鍵詞] 隱匿性陰莖;治療;外科手術

[中圖分類號] R697+.1[文獻標識碼] A[文章編號] 1004-8650(2009)05-041-02

Management of concealed penis with modified Shiraki procedure: report of 26 cases

LIU Chang-hua, WU Hong-fei, HUA Li-xin

(ShuyangXian C hinese Medicine Hospital.Shu Yang 223600.)

[Abstract] Objective To improve the management of concealed penis. Methods Modified Shiraki procedure was performed in 26 boys with concealed penis, and HCG were applied in 5cases after operation.Results Incisions of all 26 patients were primary healing without obvious complications. The follow-up duration ranged from 3 months to 5 years postoperatively. The outcomes were satisfying in 25(96.2%) boys just after operation,while the shape was not gained in a 10year- old patient. Conclusion Modified Shiraki procedure is an ideal method in the management of concealed penis.

[Key words] Concealed penis; treatment; surgical intervention

隱匿性陰莖是陰莖體顯露異常的一種先天性畸形,多發生于青春期前的兒童。因病人均為包莖, 在臨床上易誤診為包莖而行包皮環切術。小兒隱匿性陰莖隨著小兒肥胖癥的增多也有增多的趨勢。2001年1月-2008年8月,我們采用Shiraki術為基本術式并加以改進,對26例隱匿性陰莖患兒進行治療,效果滿意,現報告如下。

1資料與方法

1.1一般資料

26例患者年齡2.5-10歲,平均6.5歲。主要臨床表現為陰莖短小,外觀呈圓錐形,包莖,恥骨前方脂肪墊肥厚,用手向陰莖跟部推擠皮膚可見有正常陰莖體外露,松手后陰莖體很快回縮。肥胖兒童13例,占50%;觸診陰莖海綿體發育正常。

1.2手術方法

采用Shiraki術為基本術式,并加以改進:①向恥骨推壓陰莖,暴露龜頭,于包皮外板2、6、10點處各作縱行切開,由冠狀溝處開始,三切口止于包皮端。游離包皮外板,使遠端呈3個三角形的皮瓣。②于包皮內板相當于外板三角瓣尖端處縱行切開,即相當于4、8、12點處切開包皮內板,止距冠狀溝0.5cm。……