Name: microscopic replantation of penile glans amputation due to circumcision
Uploaded: 2022-06-03T14:00:00
Description: Watch this Scientific Journal Video about Microscopic Replantation of Penile Glans Amputation Due to Circumcision at JoVE.com

该协议是根据《赫尔辛基宣言》的原则进行的，此处描述的所有方法均已获得大坪医院伦理委员会的批准，并获得了患者的书面同意。
1. 操作仪器
<ol><li>在5-10倍放大倍率的手术显微镜下进行所有程序，以实现精确的吻合和解剖重建。</li>
</ol>2. 纳入和排除标准
<ol><li>使用以下纳入标准：在包皮环切术期间经历截肢的患者 ;的损伤?...

<ol>
	<li>Pippi Salle, J. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Glans+amputation+during+routine+neonatal+circumcision:+mechanism+of+injury+and+strategy+for+prevention.">Glans amputation during routine neonatal circumcision: mechanism of injury and strategy for prevention.</a> Journal of Pediatric Urology. 9, 763-768 (2013).</li><li>Rizvi, S. A., Naqvi, S. A., Hussain, M., Hasan, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Religious+circumcision:+a+Muslim+view.">Religious circumcision: a Muslim view.</a> BJU International. 83, 13-16 (1999).</li><li>Weiss, H. A., Larke, N., Halperin, D., Schenker, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+circumcision+in+male+neonates,+infants+and+children:+a+systematic+review.">Complications of circumcision in male neonates, infants and children: a systematic review.</a> BMC Urology. 10, 2 (2010).</li><li>Harrison, N. W., Eshleman, J. L., Ngugi, P. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ethical+issues+in+the+developing+world.">Ethical issues in the developing world.</a> BJU International. 76, 93-96 (1995).</li><li>Ceylan, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Severe+complications+of+circumcision:+an+analysis+of+48+cases.">Severe complications of circumcision: an analysis of 48 cases.</a> Journal of Pediatric Urology. 3 (1), 32-35 (2007).</li><li>Okeke, L. I., Asinobi, A. A., Ikuerowo, O. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epidemiology+of+complications+of+male+circumcision+in+Ibadan,+Nigeria.">Epidemiology of complications of male circumcision in Ibadan, Nigeria.</a> BMC Urology. 6, 21 (2006).</li><li>Shabanzadeh, D. M., Clausen, S., Maigaard, K., Fode, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Male+circumcision+complications+-+A+systematic+review,+meta-analysis+and+meta-regression.">Male circumcision complications - A systematic review, meta-analysis and meta-regression.</a> Urology. 152, 25-34 (2021).</li><li>Aboutaleb, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reconstruction+of+an+amputated+glans+penis+with+a+buccal+mucosal+graft:+case+report+of+a+novel+technique.">Reconstruction of an amputated glans penis with a buccal mucosal graft: case report of a novel technique.</a> Korean Journal of Urology. 55 (12), 841-843 (2014).</li><li>Co&#349;kunfirat, O. K., Sayilkan, S., Velidedeoglu, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Glans+and+penile+skin+amputation+as+a+complication+of+circumcision.">Glans and penile skin amputation as a complication of circumcision.</a> Annals of Plastic Surgery. 43 (4), 457 (1999).</li><li>El-Bahnasawy, M. S., El-Sherbiny, M. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Paediatric+penile+trauma.">Paediatric penile trauma.</a> BJU International. 90 (1), 92-96 (2002).</li><li>Petrella, F., Amar, S., El-Sherbiny, M., Capolicchio, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Total+glans+amputation+after+neonatal+circumcision.">Total glans amputation after neonatal circumcision.</a> Urology Case Reports. 37, 101624 (2021).</li><li>Raisin, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Glans+injury+during+ritual+circumcision.">Glans injury during ritual circumcision.</a> Journal of Pediatric Urology. 16 (4), 471 (2020).</li><li>Nasr, R., Traboulsi, S. L., Abou Ghaida, R. R., Bakhach, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Iatrogenic+penile+glans+amputation:+major+novel+reconstructive+procedure.">Iatrogenic penile glans amputation: major novel reconstructive procedure.</a> Case Reports in Urology. 2013, 741980 (2013).</li><li>Yosra, K., Wiem, H., Mourad, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Saving+an+amputated+glans:+Role+of+winter+shunt.">Saving an amputated glans: Role of winter shunt.</a> Journal of Pediatric Urology. 16 (2), 238-240 (2020).</li><li>Manentsa, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+high+volume+circumcision:+glans+amputation+in+adolescents;+a+case+report.">Complications of high volume circumcision: glans amputation in adolescents; a case report.</a> BMC Urology. 19 (1), 65 (2019).</li><li>Wang, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microscopic+Replantation+of+Complete+Penile+Amputation+With+Video+Demonstration.">Microscopic Replantation of Complete Penile Amputation With Video Demonstration.</a> Urology. , (2022).</li></ol>

出于宗教或治疗目的，全世界约有四分之一的男性接受过包皮环切术1。并发症的发生率远非微不足道，约为 1%-20%3，4，5，6，7。包皮环切术相关的截肢极为罕见，并且没有确切的统计数据描述其发病率。由于情况很少，以前的报告大多是病例报告或病例系?...

全世界约有25%的男性接受了包皮环切术1，2。中国的包皮环切术主要在儿童时期进行。在过去的几十年里，手术技术和设备的改进使包皮环切术变得不那么复杂，更快，包皮环切术后的并发症也更少。然而，这些设备的普及也带来了新的挑战。
包皮环切术后并发症的发生率约为 1%-20%，大多为轻度3，4，5，6，7。在最近的一项荟萃分析中，包括351项研究，涉及4，042，988名受试者，总体并发症风险为3.84%（95%可信区间3.35-4.37）7。包皮环切术相关的截肢是手术过程中相当罕见但毁灭性的伤害。这种并发症通常通过简单的止血来治疗，以实现自愈，早期粗体再植或延迟整形手术8，9。然而，如果处理不当，这些可能导致外观和功能的永久性损伤，以及心理问题 8 ， 9 。由于中国公众健康意识的提高和各种缝合装置的使用，截肢的预防和治疗最近发展成为包皮环切术的一个具有挑战性的问题。目前没有治疗这种损伤的现有方案或指南，这可能是由于其罕见性。因此，对截肢的损伤机制没有统一的认识，缺乏早期治疗管理或预防策略。
在这项研究中，我们报道了包皮环切术期间可剥离的吻合器引起的一系列截肢病例，这些病例通过显微外科手术成功治疗。通过视频介绍了显微外科手术的技术细节，并讨论了其可能的损伤机制和预防策略。该方案适用于所有由意外损伤引起的截肢患者的早期显微镜再植。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Catheter&#160;</td>
			<td>Guangzhou Weili Co., Ltd</td>
			<td>12 Fr</td>
			<td></td>
		</tr>
		<tr>
			<td>Cefuroxime sodium</td>
			<td>Yiyi Saite, Co., Ltd</td>
			<td>0.75 g</td>
			<td></td>
		</tr>
		<tr>
			<td>Cis-atrecu besylate</td>
			<td>Jiangsu Dongying CO.,&#160; Ltd</td>
			<td>10 mg</td>
			<td></td>
		</tr>
		<tr>
			<td>Operating microscope system</td>
			<td>Carl Zeiss Co., Ltd</td>
			<td>OPMI VARIO 700&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Pentylpheptyl ether hydrochloride</td>
			<td>Chengdu Lisi Co., Ltd</td>
			<td>1.0 mg</td>
			<td></td>
		</tr>
		<tr>
			<td>Prolene</td>
			<td>Ethicon, LLC</td>
			<td>W2777/2780</td>
			<td></td>
		</tr>
		<tr>
			<td>Sufentanni citrate</td>
			<td>Renfu Phermaceutical</td>
			<td>50 &#181;g</td>
			<td></td>
		</tr>
		<tr>
			<td>Vicryl</td>
			<td>Ethicon, LLC</td>
			<td>W9981</td>
			<td></td>
		</tr>
	</tbody>
</table>

microscopic replantation of penile glans amputation due to circumcision

使用一次性订书机的包皮环切术在中国正变得相当流行。然而，手术不当也带来了截肢的风险，这是一种非常罕见的医源性生殖器损伤。这种并发症通常通过简单的止血来治疗，以实现自愈，早期粗体再植或延迟整形手术。然而，这些可能导致明显的不利结果，例如截肢丢失，坏死，畸形愈合或尿道口狭窄。在本研究中，我们采用显微镜再植作为紧急方法，以实现的精确吻合和解剖重建。该协议的目标是为截肢提供详细的应急管理策略和细致的手术技能。术后结果显示，的原始形状得到完美恢复，外观令人满意。排尿功能完全恢复正常，没有任何明显的并发症。截肢区域的感觉也没有显着减少。因此，尽早进行细致的显微镜再植是包皮环切术导致截肢的理想应急管理策略。

3例7-8岁儿童在2019年6月至2021年7月受伤后2-3小时内，在损伤后2-3小时内被送往医院，这些儿童在2019年6月至2021年7月期间使用包皮环切术完全（2例）或不完全（1例）截肢。体格检查证实，约 1 / 3 的远端和 3 - 4 mm 的尿道远端完全或不完全截肢。在一个严重的情况下，腹侧的包皮内板和包皮系带也严重受损。受伤后完全截肢的组织保持无菌状态并暂时储存在冰桶中。对所有患者成功进行了显微镜再植...

Watch this Scientific Journal Video about Microscopic Replantation of Penile Glans Amputation Due to Circumcision at JoVE.com

Microscopic Replantation of Penile Glans Amputation Due to Circumcision

本方案描述了包皮环切术导致截肢的显微镜再植的应急管理。

包皮环切术导致截肢的显微镜再植

Circumcision using a disposable stapler is becoming quite popular in China. However, improper surgical procedures also bring the risk of penile glans ...

包皮环切术导致截肢的显微镜下再植。包皮环切术期间的截肢是一种非常罕见但具有破坏性的并发症。这种并发症通常通过简单的止血来治疗，以实现自愈，早期大体再植或延迟整形手术，从而导致明显的并发症，例如截肢丢失，坏死，畸形愈合或尿道口狭窄。因此，很明显，这种损伤往往会导致外观和功能的永久性损伤，如果处理不当，还会带来心理问题。我们使用微观技术开发了一种新的应急策略，以实现早期精确的解剖再植和重建。患者在使用一次性订书机进行包皮环切术时受伤。远端完全或不完全截肢。总共有三个主要步骤。第一步，修复截肢的和包皮系带。应用 8-0不可吸收的线缝合的内海绵状切口。同时，使用 6 - 0 可吸收线缝合表面的撕裂。第二步，端到端尿道吻合口。将截肢的和包皮系带与残端对齐。通过尿道口插入8Fr的Foley导管，用于尿液引流。使用6-0可吸收线通过间歇缝合方法进行端到端尿道吻合术，并精确定位。通常，首先在尿道的12：00和六点钟缝合一针，然后在两个定位点的底部，分别在左右两侧以逆时针或顺时针方向缝合约四针。第三步，截肢表面的吻合口和系带的重建。使用 6 - 0 可吸收线将截肢的边缘缝合到残端的边缘。首先在6点钟、12点、9点钟和3点钟位置缝合几个固定点，然后用一毫米的空间缝合固定点之间的空间，实现精确的吻合。修剪腹侧多余的包皮间板。通过间歇缝合重建系带，以达到满意的形状。三名患者的修复良好，术后外观正常。不同时间的术后观察。手术后一天，区域呈深红色并充血。手术一周后，重新种植的和包皮系带的表面变黑，这可能是表皮结痂组织。术后一个月，形态基本恢复正常，小黑痂。手术两个月后，的形态恢复正常。手术两年后，和排尿的形态完全正常。代表性成果。2019 年 6 月至 2021 年 7 月，使用一次性订书机进行包皮环切术期间，三名 7 至 8 岁的儿童完全或不完全截肢，被送入我院。冷暖缺血时间为零至五个半小时。手术时间约为两个小时。随访结果显示，所有孩子的愈合良好。的原始形状得到了完美的恢复，并获得了令人满意的美容外观，没有任何明显的并发症。结论：尽早一丝不苟的显微再植是截肢的理想早期紧急治疗方法，可以达到完美的外观，无明显并发症或功能缺陷。

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