包皮环切吻合器(商环)外置式包皮环切术616例临床分析

摘要

目的:探讨一次性包皮环切吻合器(商环)外置式包皮环切术的临床疗效及不良反应,便于临床医生学习和掌握商环的临床应用技巧,减少并发症的发生.方法:回顾性分析616例包皮过长和包茎患者,年龄7 ～ 82岁,平均26岁,其中包皮过长545例,包茎71例,伴尖锐湿疣9例,已婚232例,未婚384例,对手术时间、术中出血、术后感染、水肿、疼痛、伤口裂开、环大小的选择及术后外观满意度等进行观察.结果:手术平均时间为(6.34±0.52) min,术中出血量为(0.2±0.1)mL,术中疼痛评分为(2.45±1.21)分,术后24h疼痛评分为(4.72±0.83)分,取环时疼痛评分为(5.35±1.24)分;术后感染13例(2.1％),轻度水肿310(50.3％),取环后2～4周基本消除;中度水肿56例,占9.1％,取环后嘱患者热敷、按摩,2～3个月后水肿基本消除;伤口裂开延迟愈合3例(0.5％),术后渗血5例(0.8％),未做处理;术后外观满意度96.3％(593/616).结论:商环外置式包皮环切术手术时间短,方法简单、易掌握,术中出血少、术后感染低、疼痛轻、并发症少,切口外形美观、满意度高,优于传统的环切术,特别适合基层医院开展.%Objectives:To investigate the efficacy and complications of no-flip Shang ring circumcision in order to help clinical medical workers to learn and master the technic,and to avoid complication.Methods:616 cases (aged 7-82 years,mean of 26 years old) were observed and evaluated by following items:545 cases with redundant prepuce,71 cases with phimosis,9 cases complicated with venereal verruca;232 cases of married and 384 cases of unmarried.The operation time,intra-operative blood loss,post-operative infection,edema,pain,wound dehiscence,choice of ring size,level of satisfactory towards the penile appearance were all compared.Results:The average operation time was (6.34 ± 0.52) min;intra-operative blood loss was (0.2 ± 0.12) ml;intra-operative pain score was (2.45 ± 1.21);post-operative pain score after 24 hours was (4.72 ±0.83);pain score caused by ring removal was (5.35 ± 1.24).There were 13 cases (2.1％) of postoperative infection;310 cases (50.3％) of mild edema,which disappeared 2 to 4 weeks after ring removal;56 cases (9.1％) of moderate edema after ring removal,which disappeared 2 to 3 months by fomentation and massage.There were 3 cases (0.5％) of wound dehiscence and slow healing and 5 cases (0.8％) of postoperative blood oozing with no special treatment.Postoperative penile appearance satisfaction was 96.3％ (593/616).Conclusion:The no-flip Shang ring circumcision is of shorter operation time,simpler and easier to master with less blood loss,low infection rate,less pain,fewer complications and better wound appearance.It is better than the traditional circumcision and can be extended to any basic-level countryside hospitals easily.