环扎法矫治包茎及包皮过长48例报告

的　探索包茎及包皮过长矫治的理想方法。方法　用自行设计的包皮环扎法对包茎及包皮过长进行矫治。结果　４８ 例患者均于术后６ ～８ｄ ,包皮自行枯死脱落,伤口愈合,随访６ 个月至１ 年,形态及功能恢复满意。结论　该方法操作简单、创伤小、出血少、疼痛轻、包皮创缘整齐,是整形包皮的有效方法。     

小儿塑料套环包皮环切术1 000例报告

目的总结塑料套环包皮环切术治疗小儿包茎的经验。方法对1994～2004年行塑料套环包皮环切术治疗小儿包茎1000例进行回顾性分析。结果1000例小儿塑料套环包皮环切术术后效果良好。套环脱落时间最长13d，最短8d，平均9．5d。脱落后切缘整齐，外形美观。并发包皮感染3例，套环脱落4例，包皮撕裂3例，包皮环嵌入冠状沟2例，阴茎头出血1例，尿潴留1例。结论小儿塑料套环包皮环切术具有手术时间短，不出血或出血极少，组织创伤小，并发症少，患儿痛苦小，切缘整齐美观，术后护理方便，手术简单易于推广等优点。     

应用商环外置法行儿童包皮环切术的临床研究

目的评价商环外置法用于儿童包皮环切术的疗效及并发症情况。方法应用商环对147例包茎及包皮过长儿童进行包皮环切术,对手术时间、包皮愈合时间、背侧包皮切开率、疼痛程度、术后并发症、阴茎头分泌物及外观满意度进行观察和随访。结果手术时间为(6.20±2.14)min;包皮愈合时间(23.52±2.44)d;背侧包皮切开率95.24%(140/147);术后1 h疼痛评分(4.61±2.44)分;拆环时疼痛评分(6.59±2.11)分;术后并发症为包皮红肿29.25%,(43/147)、出血0.68%(1/147)、裂开0.68%(1/147),包皮粘连2.72%(4/147)、切口感染0.00%(0/147);术后外观满意度100%(147/147)。结论应用商环行儿童包皮环切术具有操作简单,手术时间短,术后并发症少,外观满意度高等优点,虽术后拆环时疼痛明显,仍是小儿包皮环切术可选择的一种手术方式。     

小儿包皮环套术与环切术的临床分析

目的探讨小儿包皮过长、包茎的手术较佳方式。方法对1997年至2005年826例(随机分为环套术631例、环切术195例)小儿包茎、包皮过长进行回顾性分析,采用x2检验。结果手术时间分别为(4±1)min和(20±5)min(P<0．01);总并发症发生率分别为5．23％(33／631)和18．97％(37／195)(P< 0．01);术后护理工作量:环套术组明显简单于环切术组。结论小儿包皮过长、包茎以包皮环套术为优。     

The response of phimosis to local steroid application

The effectiveness of topical steroid application in relieving phimosis was studied in 63 boys treated with local application of steroid ointment to the foreskin. Betamethasone valerate 0.05% (42 patients), hydrocortisone 1% (18 patients), or hydrocortisone 2% (3 patients) was applied three times daily for 4 weeks. Thirty-seven of the patients treated with 0.05% betamethasone valerate ointment (half-strength Betnovate) showed an initial improvement and circumcision was performed on 5 non-responders. Six patients showed initial improvement but later redeveloped phimosis: they were given a further course of treatment, resulting in 2 satisfactory responses and 4 failures requiring circumcision. Two patients using 2% hydrocortisone and 16 using 1% hydrocortisone ointment showed improvement, but 2 of the latter group ultimately required circumcision. Overall, a permanent improvement was achieved in 51 of the 63 patients, with the ability to retract the foreskin after one or more treatments. The remaining 12 boys required circumcision. Local application of steroid ointment to the foreskin results in resolution of phimosis in the majority of cases, but if the foreskin has a circumferential white scar, it is slightly less likely to respond. Following cessation of steriods, phimosis redevelops in a proportion of patients. Correspondence to: S. W. Beasley     

Phimosis. Preputial plasty using transversal widening on the dorsal side with EMLA local anesthetic cream

Background/Purpose

In the United States, the treatment of choice for the correction of phimosis is circumcision, whereas in European countries, the condition is usually treated by preputial plasty using Duhamel's method or modified versions. We report our experience in correcting phimosis by preputial plasty using transversal widening on the dorsal side with EMLA local anesthetic cream.

Methods

Twenty-six patients with phimosis were operated on by preputial plasty, under local anesthesia with EMLA cream. A transversal incision is made on the dorsal side of the ring of prepuce, like 3 contiguous Ts, the middle one inverted with the long arm on the preputial mucosa side. The 2 small mucocutaneous flaps of the prepuce are separated and then sutured with interrupted stitches, thus transforming the incisions from T to V.

Results

No postoperative complications were observed. At 1-year follow-up, the cosmetic and functional results were satisfactory.

Conclusions

The technique of preputial plasty that the authors present enlarges the stenotic ring of prepuce by a transversal widening on the dorsal side. The ring of prepuce obtained is wide and symmetrical on its dorsal and ventral sides and therefore cosmetically and functionally satisfactory. It is a good alternative to the more radical circumcision technique.     

A new technique for correction of disproportionate preputial growth with phimosis

A new surgical solution to correct the rare anomaly of asymmetric phimosis is described, with a note on its symptomatology and etiopathogenesis.     

Lichen sclerosus et atrophicus in children with phimosis and hypospadias

 This prospective study was designed to evaluate the incidence of lichen sclerosus et atrophicus (LSA) in a pediatric population with hypospadias and phimosis in order to discuss the indications for circumcision and utilization of preputial skin for urethral surgery. All 115 boys, 55 with congenital phimosis, 45 with acquired phimosis, 13 with hypospadias, and 2 with recurrent chronic balanitis, underwent full-thickness biopsies of the foreskin that were examined by a single pathologist. Of the patients with acquired phimosis, 88% showed inflammatory features in the foreskin; 60% had LSA. Of the patients with congenital phimosis, 82% showed inflammatory disease in the prepuce; 30% had LSA. Of the patients operated upon for hypospadias, 61% showed histologic findings of chronic inflammation of the foreskin and LSA was evident in 15%. The high incidence of LSA in the prepuce of patients with phimosis suggests that circumcision should be performed to correct this disease. The frequent presence of chronic inflammation is a possible cause of stenosis when the foreskin is used to perform a urethroplasty in patients with hypospadias. Accepted: 30 April 2001     

Z-plasty reconstruction for preputial stenosis — a surgical alternative to circumcision

ABSTRACT. A technique for the surgical treatment of phimosis of the prepuce to produce a cosmetic and functional result as an alternative to circumcision is described.     

儿童包皮环切术739例治疗体会

目的观察一次性包皮环切吻合器行儿童包皮环切术的临床运用效果,探讨应用一次性包皮环切吻合器行儿童包皮环切术的优越性。方法应用一次性包皮环切吻合器对739例包皮过长及包茎儿童行包皮环切术,对手术时间、术后并发症、术后恢复时间和外观情况进行观察。结果手术时间(5.2±1.3)分钟,主要并发症为术后感染9例(1.22%)、出血5例(0.68%)和水肿27例(3.65%)。术后包皮创口完全愈合时间为(19.90±5.33)天。结论应用一次性包皮环切吻合器行儿童包皮环切术具有手术时间短、术中疼痛轻、术后并发症少、外观满意度高、受术者易于接受等优点,值得在临床推广应用。