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包皮环切术罕见的并发症及其处理

Rarely seen complications of circumcision, and their management.

作者信息

İnce Bilsev, Dadacı Mehmet, Altuntaş Zeynep, Bilgen Fatma

机构信息

Department of Plastic, Reconstructive and Aesthetic Surgery, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey.

Clinic of Plastic, Reconstructive and Aesthetic Surgery, Necip Fazıl Hospital, Kahramanmaraş, Turkey.

出版信息

Turk J Urol. 2016 Mar;42(1):12-5. doi: 10.5152/tud.2016.78972.

Abstract

OBJECTIVE

Circumcision, performed for religious or medical reasons is the procedure of surgical excision of the skin covering the glans penis, preputium in a certain shape and dimension so as to expose the tip of the glans penis. Short- and long- term complication rates of up to 50% have been reported, varying due to the recording system of different countries in which the procedure has been accepted as a widely performed simple surgical procedure. In this study, treatment procedures in patients presented to our clinic with complications after circumcision are described and methods to decrease the rate of the complications are reviewed.

MATERIAL AND METODS

Cases that presented to our clinic between 2010 and 2013 with early complications of circumcision were retrospectively reviewed. Cases with acceptedly major complications as excess skin excision, skin necrosis and total amputation of the glans were included in the study, while cases with minor complications such as bleeding, hematoma and infection were excluded from the study.

RESULTS

Repair with full- thickness skin grafts was performed in patients with excess skin excision. In cases with skin necrosis, following the debridement of the necrotic skin, primary repair or repair with full- thickness graft was performed in cases where full- thickness skin defects developed and other cases with partial skin loss were left to secondary healing. Repair with an inguinal flap was performed in the case with glans amputation.

CONCLUSION

Circumcisions performed by untrained individuals are to be blamed for the complications of circumcision reported in this country. The rate of complications increases during the "circumcision feasts" where multiple circumcisions were performed. This also predisposes to transmission of various diseases, primarily hepatitis B/C and AIDS. Circumcision is a surgical procedure that should be performed by specialists under appropriate sterile circumstances in which the rate of complications would be decreased. The child may be exposed to recurrent psychosocial and surgical trauma when it is performed by incompetent individuals.

摘要

目的

出于宗教或医学原因进行的包皮环切术,是一种外科手术,即按特定形状和尺寸切除覆盖阴茎头的皮肤(包皮),以暴露阴茎头顶端。据报道,其短期和长期并发症发生率高达50%,因该手术在不同国家被视为一种广泛开展的简单外科手术,记录系统不同而有所差异。在本研究中,描述了因包皮环切术后出现并发症前来我院就诊患者的治疗过程,并回顾了降低并发症发生率的方法。

材料与方法

回顾性分析2010年至2013年间因包皮环切术早期并发症前来我院就诊的病例。本研究纳入了公认的主要并发症病例,如皮肤切除过多、皮肤坏死和阴茎头完全截断,而排除了轻微并发症病例,如出血、血肿和感染。

结果

皮肤切除过多的患者采用全厚皮片移植进行修复。对于皮肤坏死的病例,在清除坏死皮肤后,若出现全层皮肤缺损,则进行一期修复或全厚皮片移植修复,其他部分皮肤缺损的病例任其二期愈合。阴茎头截断的病例采用腹股沟皮瓣进行修复。

结论

该国报道的包皮环切术并发症应归咎于未经培训的人员进行手术。在“包皮环切盛宴”期间,进行多次包皮环切术时,并发症发生率会增加。这也易导致各种疾病的传播,主要是乙型/丙型肝炎和艾滋病。包皮环切术是一种外科手术,应由专科医生在适当的无菌条件下进行,这样可降低并发症发生率。若由不称职的人员进行手术,儿童可能会反复遭受心理社会和手术创伤。

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