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中华男科学杂志,2009,15(7):483-487

应用中国商环包皮环切手术标准化方案对328 例成年男性包皮环切的临床报告

程跃1,彭弋峰2,刘毅东3,田龙4,吕年青5,苏新军1,严泽军1,胡嘉盛1,Richard LEE6,Howard KIM6,David C. SOKAL7,Philip S. LI(李石华)6

1. 宁波大学医学院附属宁波市第一医院泌尿中心,浙江 宁波 315010;
2. 皖南医学院弋矶山医院性医学科,安徽芜湖 241001;
3. 上海交通大学医学院附属仁济医院泌尿科,上海 200127;
4. 首都医科大学附属北京朝阳医院泌尿科,北京 100034;
5. 江苏省计划生育科学技术研究所,江苏 南京 210036;
6. Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Department of Urology, The New York Presbyterian Hospital, Weill Medical College of Cornell University, NewYork, NY 10065- 4870, USA;
7. Family Health International, Research Triangle Park, NC27709, USA)

【摘要】

目的:成年男性包皮环切手术标准化和培训可显着降低因手术引起的并发症发生率。由于目前国内外尚无可供参考的成年男性包皮环切手术标准化方案和培训制度,使得临床医生开展成年男性包皮环切手术的质量无法保证。为了建立成年男性包皮环切手术标准化和培训制度,便于临床医生和相关医护人员学习和掌握包皮环切器的临床应用技巧,以中国商环( 简称“商环,Shang Ring”) 包皮环切技术为例,根据商环的技术特点和临床实践经验,特别制订了商环包皮环切手术标准化方案, 并将其标准化操作运用于临床。方法:采用商环包皮环切手术标准化方案对328 例受术者( 年龄18 ~58 岁,平均27.8 岁;已婚134 例, 未婚194 例;包茎25 例,包皮过长303 例) 进行包皮环切手术。对手术时间、疼痛评分( 视觉模拟评分法, VAS) 、术后并发症、包皮创口愈合时间、术后外观满意情况进行观察和随访。结果:手术时间为(4. 70 ±1. 31) min。手术时受术者疼痛( VAS) 评分为(0. 24 ±0. 59)分术后24 h疼痛评分为(1.59 ±0.95) 分,去环前24 h 内疼痛评分(1.72 ±1. 11) 分,去环时疼痛评分为( 2.72 ±1.37) 分。主要并发症发生率为术后感染0. 6%( 2/328) 、出血0. 6%( 2/328) 、伤口裂开0. 6%( 2/328) 和水肿4.89%( 16/328) 。在发生出血和伤口裂开的受术者中无1 例需要缝合。术后包皮创口完全愈合时间为(20.30 ±6.69) d。受术者对术后外观满意率99.7%( 327/328) 。结论: 商环包皮环切术具有手术方式易于标准化、手术时间短、术中疼痛轻、术后无须特殊护理、容易完整保留系带, 并完全暴露冠状沟、术后外观满意度高、受术者易于接受等优点。初步证明了中国商环包皮环切手术标准化方案的可接受性,严格按照此方案实施手术和随访护理,能最大化地实现商环包皮环切技术的诸多临床优势,将并发症发生率控制在可接受的范围内。

关键词:包皮环切术;中国商环;标准化方案;并发症;男性;成年人

中图分类号: R697+ . 1 文献标识码: A 文章编号: 1009-3591 ( 2009) 07-0584-09

 

 

Zhonghua Nan Ke Xue. 2009 Jul;15(7):584-92.

A recommendable standard protocol of adult male circumcision with the Chinese Shang Ring: outcomes of 328 cases in China.

[Article in Chinese]

Cheng Y, Peng YF, Liu YD, Tian L, Lü NQ, Su XJ, Yan ZJ, Hu JS, Lee R, Kim HH, Sokal DC, Li PS.

Department of Urology, The First Hospital of Ningbo, Ningbo University School of Medicine, Ningbo, Zhejiang 315010, China. dongbaba2@hotmail.com

Abstract

OBJECTIVE: Standardization of and training in adult male circumcision can significantly reduce its complication rate. Currently no such program exists for its standardization and training, making it difficult to guarantee the quality of male circumcision services. We therefore established a standardized surgical protocol for adult male circumcision in China using the Shang Ring, and applied it to a clinical study examining the performance of the Shang Ring in adult male circumcision.


METHODS: A total of 328 adult men aged 18-58 (mean 27.8) years, 25 with phimosis and 303 with redundant prepuce, underwent circumcision with the Shang Ring, and evaluation of the operation time, pain scores (using the visual analog scale), postoperative complications, time for wound healing, and their satisfaction with the postoperative appearance.


RESULTS: The operation time was 4.7 +/- 1.3 minutes. The pain scores were 0. 2 +/- 0.6 during the surgery, 1.6 +/- 1.0 twenty hours postoperatively, 1.7 +/- 1.1 twenty hours prior to the ring removal, and 2.7 +/- 1.4 during the ring removal. Complications included infection in 2 (0.6%), bleeding in 2 (0.6%), and wound dehiscence in 2 (0.6%) of the patients. None of the patients with wound dehiscence required postoperative suturing and all were managed conservatively instead. Sixteen of the patients (4.9%) experienced penile edema. The time for complete wound healing after circumcision was 20.3 +/- 6.7 days. The rate of the patients'satisfaction was 99.7% (327/328).


CONCLUSION: The standard protocol of adult male circumcision with the Shang Ring has the advantages of short operation time, slight pain, low rate of complications, and high satisfaction and acceptance of the patients. Strict standardization of the surgical protocol can maximize its clinical advantages for adult male circumcision.


PMID: 19694369 [PubMed - indexed for MEDLINE]

 

Note: The English translation of this article is available in a PDF file.

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