[1]周波,李彦锋,包聪聪.包皮环切术相关龟头离断伤的常见病因和治疗策略[J].第三军医大学学报,2020,42(14):1434-1440.
 ZHOU Bo,LI Yanfeng,BAO Congcong.Common causes and treatment strategies for circumcision-related glans amputation[J].J Third Mil Med Univ,2020,42(14):1434-1440.
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包皮环切术相关龟头离断伤的常见病因和治疗策略(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
42卷
期数:
2020年第14期
页码:
1434-1440
栏目:
临床医学
出版日期:
2020-07-30

文章信息/Info

Title:
Common causes and treatment strategies for circumcision-related glans amputation
作者:
周波李彦锋包聪聪
陆军军医大学(第三军医大学)大坪医院泌尿外科
Author(s):
ZHOU Bo LI Yanfeng BAO Congcong

Department of Urology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China

关键词:
包皮环切术龟头离断龟头再植龟头修复
Keywords:
circumcision glans amputation glans replantation glans repair
分类号:
R619.5; R697.1; R699.8
文献标志码:
A
摘要:

目的探讨包皮环切术相关龟头离断伤的常见病因和治疗策略。方法我院于2019年6月26日收治了1例7岁的龟头离断伤患儿。该患儿在外院接受一次性包皮切割吻合器包皮环切手术,术中发生部分龟头及系带完全离断,离体组织被装入冰盐水中保存,患儿被急诊送入我院。急诊手术中探查证实冠状沟远端约1/3龟头组织及其腹侧系带被完全铡刀样离断,遂对其实施了“显微镜下离断龟头修复+龟头再植术+尿道端-端吻合术”。同时结合该例包皮切割吻合器导致的龟头离断伤的治疗经验,通过文献复习,分析包皮环切术相关龟头离断伤的常见病因和治疗策略。结果术后患儿恢复良好,龟头外观和排尿完全恢复正常,无尿道狭窄和尿瘘出现,勃起功能正常存在。文献复习结果提示:包皮环切器械导致的龟头离断伤远远多于徒手的传统手术。Ⅰ期治疗方式最常见的为龟头再植术(54.3%)和尿道端-端吻合术(31.4%),Ⅱ期治疗方式最常见的为龟头重建术(44.4%)。结论器械操作不当是包皮环切术相关龟头离断伤发生的最主要原因。尽早进行“显微镜下龟头再植术和尿道端-端吻合术”效果较理想。如丧失早期再植机会,后期可通过龟头重建等多种技术恢复龟头外观和正常排尿。

Abstract:

ObjectiveTo discuss the common causes and treatment strategies of circumcision-related glans amputation. MethodsA 7-year-old boy underwent circumcision at a local hospital using a disposable circumcision stapler, during which complete severing of the glans penis and the frenulum occurred due to surgical error. The boy was immediately transferred to our hospital with the amputated tissue preserved in iced saline. Emergency surgical exploration confirmed that about 1/3 of the glans tissue and its ventral frenulum at the distal end of the coronary sulcus were completely severed by a guillotine-type cut. We then performed microscopic repair of the severed glans with glans replantation and end-to-end urethrostomy. Based on our experience with treatment of glans amputation caused by a circumcision stapler and review of the literature, we discuss the common causes and treatment methods of circumcision-related glans amputation. ResultsThe child recovered well after the surgery with normal morphology of the glans and normal urinary function. No ureteral stricture or urinary fistula occurred after the surgery, and the boy’s erectile function was normal. Literature review showed that amputation of the glans caused by circumcision instrument occurs much more frequently than that caused by manual operation. The most common treatment in stage I is glans replantation (54.3%) and urethra end-to-end anastomosis (31.4%), and glans reconstruction is the most common stage Ⅱ treatment (44.4%).
ConclusionImproper operation of equipment is the main cause of circumcision-related glans amputation. The ideal early treatment is microscopic replantation of the glans and end-to-end urethrostomy as early as possible. If the opportunity of early replantation is lost, various techniques such as reconstruction of glans can be used to restore the appearance of the glans and normal urinary function.

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更新日期/Last Update: 2020-07-23