皖南医学院附属二院 李杨缜 (1i-yangzhen) 李名杰 (li-mingjie)* 商建忠
(shang-jianzhong)** 汪桐 (Wang-tong)***
包皮过长的经典治疗方法为包皮坏切手术，至今无突破性进展。2003年10至2005年2月，我院采用微创手术坏治疗包皮过长52例，现报告如下。
材料与方法
一、临床资料
本组52例，年龄最小17岁，最大56岁，平均38岁，术前阴茎静态下最短 2.5cm，最长10cm，其中已婚 40 例，未婚12例。
二、手术方法
1、取材: 手术采用中国管理科学院特约研究员商建忠先生发明的微创手术环(专利号2003.ZL02 2 37969.X）。此手术环选取聚丙烯工程塑料模压面成，器械分内坏与外环部分，二环合拢以螺丝连接卡压。产品分不同型号，为无菌包装一次件使用。(附图)
附图1 微创包皮环切器内环 微创包皮环切器外环 微创包皮环切器整体（见插图）
2、手术方法: 消毒，铺洞巾，暴露阴茎: 在阴茎根部以橡皮筋止血带环绕阴茎根部，阻断静脉回流，作怒张的静脉穿刺，抽吸积血，注入用2%利多卡因2ml，待5分钟，麻醉十分满意、完全。选用适当型号包皮手术环，先将内环套上阴茎。外翻包皮至内环上，如系包茎需在背侧切开少许，充分暴露龟头，内板保留至冠状沟以远0.5Cm，系带部略长约1.0cm，套上外环，旋紧螺丝，切平压环外多余包皮，用无菌纱布条覆盖创面，龟头外露，解除止血带，术毕。6天后去环，约15-20天痊愈。附图2 微创包皮手术愈合后 微创包皮手术完成 微创包皮手术前（见上插图）。
结 果
52例中，术后伤口一期愈合50例，2例因未遵医嘱，提前性生活而感染，愈合期延迟。无远期后遗症，愈后无疤痕。
讨论
包皮过长，因冠状沟不能外露造成长期分泌物过多不能及时消除而引起包皮炎，长时间的炎性刺激还可诱发阴茎癌。包茎可使阴茎发育不良，并影响性生活，包皮过长是困扰男性患者的一种常见病。微创包皮环切术适用于男性包皮过长及包茎者、传统治疗方法，即包皮环切，需要切除、止血、缝合，愈合后尚留有疤痕; 激光手术又有热力伤等弊端。
本疗法突破传统思维模式，无需手术切割与缝合，环压后使远端局部组织缺血、坏死而脱落，而完成包皮环切。一般6天左右下环，15-20左右痊愈，愈合后无疤痕，手术时间仅2-5分钟。不另需任何医疗器械，避免了繁琐的止血步骤。且感染发生率低，无需服用雌激素，术后可自由活动，生活无不便，可洗澡，不影响排尿，无并发症
新型方法与传统方法比较
| 新型方法 | 传统方法(环切、激光) | |
| 1、手术方式 | 微创、简便 痛苦小，无疤痕 |
有创，繁琐 痛苦大，有疤痕 |
| 2、人力配备 | 施术者一般只需1人 | 施术者最少2人 |
| 3、材料消耗 | 无需手术器械，成本小 | 需在手术室，必备手术器械 |
| 4、创口出血 | 无出血，无需止血 | 止血烦琐 |
| 5、手术时间 | 小于5分钟 | 大于 30 分钟 |
| 6、费用 | 花费少 | 需一定经费 |
由于解除了包皮的束缚，本疗法52例中，术后部分患者阴茎不同程度增长、增粗，同时性功能增强。
结论: 这种全新型微创式手术方法优于传统方法，疗效肯定，值得推广。
作者单位: 中国安徽皖南医学院附属二院 (芜湖24100)
E-mail: lmj@mail.ahwhpit.net.cn
* 中国安徽芜湖长航医院
** 中国管理科学院
*** 中国安徽皖南医学院
Clinical study of a novel circumcision with minimal invasion for phimosis
INTRODUCTION:
Conventional circumcision remains a traditional and the most common surgical option for phimosis and paraphimosis. There has not been a breakthrough in technology so far. In this report. we presented a novel operative technique, invented by Dr. Shang to remove the prepuce with minima invasion, and reported a study from 52 patients diagnosed of phimosis or paraphimosis and treated with this technique, from October 2003 to February 2005 in the 2nd Affiliated Hospital of Wannan Medical College.
MATERIALS AND METHODS:
Clinical data:
Fifty-two patients with phimosis or paraphimosis were included, 40 of them were married and 12 were unmarried, from the age of 17 years to 56 years with a mean age of 38 years. The length of resting penises ranged from 2.5 to 10 cm.
Surgical Procedure:
Material: the unique tool, called Noninvasive Operation Loops (patent number, 2003.ZL02237969.X), used for the operation, was invented by Dr. Jianzhong Shang, a special scientist of Chinese National Management Institute. These noninvasive operation loops cast in polypropylene engineering plastic consisting of an inner loop and an outer loop. These two loops can be held together through compression by screws. These noninvasive operation loops are composed of various sizes. packaged in sterile and disposable. (See figures in Figure1 (Legend: Inner loop, Outer loop, Combined loops).
Surgical Procedure: sterilize. unfold surgical towel, and expose the penis; block venous blood return with rubber cuff placed at the root of penis, extract venous blood from extended veins by a needle puncture, and slowly inject 2 ml of 2% lidocaine, wait for 5 minutes until anesthesia is completed and satisfactory; select a proper size of operation loop, first put the inner loop around penis, turn the foreskin outwardly to cap the inner loop, fully expose the glans, for phimosis, cut open the foreskin ventrally, place the inner loop 0.5 cm above the corona, and around 1.0 cm above penile ligament, cap the outer loop, and tie up screws. excise the extra foreskin along the outer loop. Expose the glans while covering wounds with sterile gauzes, and release cuff. Six days after surgery, remove loops, and the wound would fully heal within 15-20 days. (Figure 2: Prior surgery, operation completion, and after surgery)
RESULTS:
After the operation, 50 out of 52 patients had primary wound healing. The remaining two individuals showed delayed wound healing secondary to wound infection caused by premature sexual intercourse in the ignorance of medical instructions. There was no scaring and no sequelae.
DISCUSSION:
Phimosis is a condition in which the foreskin cannot be retracted behind the glans penis. It may produce urinary obstruction with ballooning the foreskin and may lead to penile undergrowth and maidevelopment? in boys, recurrent meatitis and balanitis (i.e.. inflammation of the glans), and even penile carcinoma. It might affect patients' sex life. Phimosis is not uncommon. Our new approach is indicated to patients with phimosis and paraphimosis. Conventional circumcision has traditionally been regarded as the treatment of choice for phimosis and paraphimosis. It requires multiple procedures such as incise. stanch, and suture. It is going to have a scar after healing. The laser operation procedure has its own disadvantages such as a thermal burn.
Our approach offers a breakthrough from traditional modes of thinking. The procedures in this revolutionary approach no longer require incision and suture. By compression of the operation loops, consequently, the distal part of the foreskin becomes ischemic, necrotic, and thus shed. The surgical procedures only take 2-5 minutes to complete. The operation loops are usually removed in 6 days after surgery. The wound heals in 15-20 days without scarring. No complex surgical tools are needed. Miscellaneous procedures such as stanching are avoided, therefore, the incidence of postoperative infection and other complications is significantly low. It is not necessary to take any medications such as estrogen or to limit daily activities such as taking a shower. It does not affect urination and has no complications.
Comparison between our novel approach and traditional circumcision:
Novel Circumcision Traditional Circumcision
Surgical procedures:
near noninvasive, simple, less painful, and no
scarring
invasive, complex, more painful, and scarring
Personnel requirement:
usually only one surgeon
at least two surgeons
Material consumption:
no conventional surgical tools required
both conventional surgical tools and an operation room required
Wound bleeding:
no bleeding, no stanching
stanching
Operation time:
less than 5 minutes
more than 30 minutes
Cost:
less costly
more costly
Because of the removal of the un-retractable foreskin, in a portion of our 52 patients with phimosis, the postoperative penis becomes longer and sturdy and improves its sexual function in variable degrees.
CONCLUSION:
Our new method of circumcision with minimal invasion is superior to the traditional one with convincing curative effects. It deserves as a treatment of choice or at least as a viable alternative for phimosis.
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