皮瓣转移联合改良Devine术或改良Brisson术矫正误行包皮环切术的小儿隐匿性阴茎的效果比较

Comparison of the effect of flap transfer combined with modified Devine or Brisson procedure in correction of concealed penis in mistakenly-circumcised children

摘要:

目的 比较皮瓣转移联合改良Devine术或改良Brisson术矫正误行包皮环切术的小儿隐匿性阴茎的效果。方法 前瞻性选取2020年9月—2023年1月南通市第一人民医院收治的92例误行包皮环切术的隐匿性阴茎患儿，以随机数字表法分为对照组和研究组，每组46例。对照组给予皮瓣转移联合改良Devine术，研究组给予皮瓣转移联合改良Brisson术，术后随访6个月。比较两组患儿的手术情况、疼痛情况、围手术期应激反应、术后恢复情况、并发症及患儿家属满意情况。结果 两组患儿手术时间比较，差异无统计学意义（P >0.05），研究组术中出血量低于对照组（P <0.05）。两组术后4、12和24 h的儿童疼痛行为量表（FLACC）评分比较，结果 ①不同时间点的FLACC评分比较，差异有统计学意义（P <0.05）；②两组FLACC评分比较，差异无统计学意义（P >0.05）；③两组FLACC评分变化趋势比较，差异无统计学意义（P >0.05）。两组术前、术后24 h的肾上腺素（Adr）、皮质醇（Cor）比较，差异均无统计学意义（P >0.05）。两组术后阴茎长度均高于术前（P <0.05），研究组术后阴茎长度和阴茎延长长度均高于对照组（P <0.05）；两组术后包皮水肿时间比较，差异无统计学意义（P >0.05）。两组总并发症发生率比较，差异无统计学意义（P >0.05）。研究组家属总满意度高于对照组（P <0.05）。结论 皮瓣转移联合改良Devine术或改良Brisson术矫正误行包皮环切术的小儿隐匿性阴茎均为安全、有效术式，但皮瓣转移联合改良Brisson术在延伸患儿阴茎长度、提升患儿家属满意度方面更具优势。

Abstract:

Objective To compare the effect of flap transfer combined with modified Devine or Brisson procedure in correction of concealed penis in children who were mistakenly circumcised.Methods Data of 92 children with concealed penis who were mistakenly circumcised in our hospital from September 2020 to January 2023 were prospectively selected and divided into the control group and the study group by the random number table method, with 46 cases in each group. The control group received flap transfer combined with modified Devine surgery, and the study group received flap transfer combined with modified Brisson surgery. All of the children were followed up for 6 months. The operation, pain, perioperative stress response, postoperative recovery, complications and family satisfaction were compared between the two groups.Results There was no significant difference in the operative duration between the two groups (P > 0.05), and the amount of intraoperative blood loss in the study group was lower than that in the control group (P < 0.05). The Face, Legs, Activity, Cry, Consolability (FLACC) scores 4 h, 12 h and 24 h after the surgery were compared between the two groups, and the results showed that the FLACC scores were different among the time points (P < 0.05) but not between the two groups (P > 0.05), and that the change trends of FLACC scores were not different between the two groups (P > 0.05). There was no significant difference in the levels of adrenaline (Adr) and cortisol (Cor) between the two groups before and 24 h after surgery (P > 0.05). The postoperative penile length of the two groups was higher than that before surgery (P < 0.05), and the postoperative penile length and the increased penile length of the study group were higher than those of the control group (P < 0.05). There was no significant difference in the duration of postoperative preputial edema between the two groups (P > 0.05). There was no significant difference in the overall incidence of complications between the two groups (P > 0.05). The family satisfaction in the study group was higher than that in the control group (P < 0.05).Conclusions Flap transfer combined with modified Devine or Brisson is safe and effective for correction of concealed penis in children who were mistakenly circumcised, but flap transfer combined with modified Brisson is more advantageous in extending the penile length of children and improving the family satisfaction.