Clinical application value of removal of deep penile dartos in the treatment of concealed penis by modified Devine's operation
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摘要: 目的 探讨阴茎深层肉膜切除在改良Devine术治疗隐匿性阴茎中的应用价值。方法 回顾性分析2017年11月—2021年6月在南京医科大学附属江宁医院泌尿外科手术治疗的62例隐匿性阴茎患者的临床资料，按手术方式分为2组，采用阴茎深层肉膜切除的改良Devine术式34例为研究组，仅行阴茎肉膜纤维束带松解的改良Devine术式28例为对照组，对比分析2组的一般资料、手术效果、术后并发症等指标。结果 研究组和对照组术后即刻阴茎平均伸长长度分别为(3.3±0.7) cm和(3.2±0.6) cm、术后12个月较术前平均伸长分别为(3.4±0.8) cm和(3.2±0.8) cm，差异无统计学意义(P>0.05)；但术后12个月研究组未出现阴茎回缩病例，对照组5例出现阴茎回缩(P=0.036)；术后1、3周研究组包皮水肿发生率均小于对照组(P＝0.044、0.011)；术后12个月，研究组和对照组综合评分分别为(8.5±0.9)分和(7.4±1.2)分，差异有统计学意义(P < 0.001)；满意度评分(FIPS)分别为(1.4±0.4)分和(1.7±0.6)分，研究组均优于对照组(P=0.045)。结论 改良Devine术中行阴茎深层肉膜切除等改进措施，可进一步减少术后阴茎回缩、减轻术后水肿的发生，对提高患者术后满意度具有一定的价值。Abstract: Objective To explore the application value of removal of deep penile dartos in the treatment of concealed penis.Methods The clinical data of 62 patients with concealed penis treated in the Department of Urology of our hospital from November 2017 to June 2021 were collected, and all patients were divided into two groups according to the operation method. Study group included 34 cases who received modified Devine's operation with removal of deep penile dartos, while control group included 28 cases who received modified Devine's operation with release of penile dartos fiber band. The general data, operation effect, postoperative complications and other indexes of the two groups were compared and analyzed.Results The immediate postoperative average length of penile elongation in the study group and the control group were (3.3±0.7) cm and (3.2±0.6) cm, respectively (P > 0.05). The average length of penile elongation at 12 months after operation were (3.4±0.8) cm and (3.2±0.8) cm respectively (P > 0.05). At 12 months after operation, there was no case of penile retraction in the study group, but 5 cases in the control group (P=0.036). At 1 and 3 weeks after operation, the incidence of prepuce edema in the study group were lower than those in the control group (P=0.044, 0.011). Twelve months after operation, the comprehensive scores of the study group and the control group were (8.5±0.9) and (7.4±1.2), respectively (P < 0.001), and the FIPS scores were (1.4±0.4) and (1.7±0.6), respectively (P=0.045).Conclusion Removal of deep penile dartos during modified Devine's operation may further reduce postoperative penile retraction and reduce the occurrence of postoperative edema, which is of certain value in improving patients' postoperative satisfaction.
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表 1 2组患者一般资料及手术效果比较
X±S 项目 研究组(34例) 对照组(28例) P值 年龄/岁 13.9±5.0 12.9±3.6 0.337 BMI/(kg/m2) 26.0±2.8 26.3±2.7 0.650 手术时间/min 59.4±6.6 56.8±5.5 0.105 术前阴茎长度/cm 3.8±1.6 3.7±1.5 0.695 术后即刻阴茎伸长/cm 3.3±0.7 3.2±0.6 0.564 术后6个月阴茎伸长/cm 3.4±0.8 3.1±0.7 0.183 术后12个月阴茎伸长/cm 3.4±0.8 3.2±0.8 0.264 术后手术效果综合评分/分 8.5±0.9 7.4±1.2 < 0.001 FIPS/分 1.4±0.4 1.7±0.6 0.045 
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表 2 2组患者术后并发症比较
例(%) 项目 研究组(34例) 对照组(28例) P值 包皮水肿 术后1周 0.044 无 26(76.5) 15(53.6) 轻度 7(20.6) 9(32.1) 重度 1(2.9) 4(14.3) 术后3周 0.011 无 34(100.0) 23(82.1) 轻度 0 4(14.3) 重度 0 1(3.6) 包皮皮赘 0 2(7.1) 0.200 阴茎回缩 0 5(17.9) 0.036
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