激光治疗包皮过长并STD疗效观察

目的探讨激光包皮环切术联合氦氖激光治疗包皮过长并性传播疾病（STD）的临床疗效。方法将包皮过长并STD的患者260例,随机分为治疗组130例,对照组130例。两组治疗后,均随访6个月,对两组疗效及复发率进行对比。结果治疗组痊愈103例,显效10例,有效9例,总有效率为93.85%;对照组痊愈73例,显效19例,有效6例,总有效率为75.38%,两组疗效比较,差异显着（z=-4.23,P=0.000 P〈0.001）;随访6个月,治疗组103例,复发13例,复发率为12.62%,对照组73例,复发27例,复发率为36.98%,两组复发率比较,差异显著（x2=14.42 P=0.000 P〈0.001）。结论 CO2激光包皮环切术治疗包皮过长并STD,临床疗效显着,复发率低,值得临床推广。     

单人操作包皮环切术的临床研究

目的探讨一种改良包皮环切手术方法的可行性及优越性。方法应用我科自行设计的单人操作包皮环切术治疗包茎及包皮过长2306例。总结该手术方法的手术时间、失血量、术后并发症、术后外观满意情况等。结果 2306例手术均获满意效果。手术时间20~45 min,平均28 min。失血0.5~1.0 ml。术后伤口整齐,水肿轻。有5例患者术后当夜阴茎勃起较甚致伤口出血,再次缝合止血。11例患者术后伤口裂开,于术后10 d二期缝合伤口,另2295例患者伤口7~10 d愈合。结论单人操作包皮环切术手术简单、快捷。不需要助手,术者一人即可独立完成,并且具有出血量少,术后恢复快,切口美观、瘢痕少等特点,是一种值得推广的手术方法。     

The risk factors of recurrent urinary tract infection in infants with normal urinary systems

Urinary tract infection (UTI) frequently recurs and increases the risk of renal scarring even in infants with normal urinary tracts. Our study was aimed to find preventive measures for recurrent UTI in these infants. One-hundred ninety infants, who were diagnosed with their first febrile UTI and were proven to have normal urinary systems, were enrolled. We investigated the incidence of recurrent UTI during the following year and the following risk factors: gender, young age, phimosis, vaginal reflux, and acute pyelonephritis (APN) diagnosed by 99m-technetium dimercaptosuccinic acid ((99m)Tc-DMSA)(+) scintigraphy. The incidence of recurrent UTI was 21.1%. The difference in recurrence rate according to gender was not significant. The recurrence rate in infants less than 6 months of age was 25.8%, which was significantly higher than the 7.7% in older infants (P = 0.045). In male infants with persistent non-retractile prepuces, recurrent UTI developed in 34.0%, which was significantly higher than the 17.6% in male infants with retractile prepuces (P = 0.022). The presence of APN in male infants increased the likelihood of recurrent UTI when analyzed by multivariate logistic regression [odds ratio 4.6, 95% confidence interval (95% CI) 1.6-13.0, P = 0.003]. The presence of vaginal reflux and APN in female infants gave no significant difference to the incidence of recurrent UTI. In infants with normal urinary systems, age less than 6 months, non-retractile prepuces and APN in male infants, were the most important risk factors for recurrent UTIs. It is suggested that non-retractile prepuces should be adequately treated to become retractile in young male infants with APN.     

几种包皮环切术式的临床观察比较

目的:探讨不同方法行包皮环切术的临床效果.方法:回顾性分析2008年1月至2011年8月采用不同方法行包皮环切术的临床资料1 247例.其中传统包皮环切术982例、激光袖套状包皮环切术123例、包皮环环扎术142例,并对其手术平均耗时、水肿消退期时间、术后并发症如术后创口出血、术后感染、术后线头反应、术后伤口裂开、再次手术率,进行临床观察比较.结果:传统包皮环切术组的手术时间(26.8±5.9) min及术后水肿消退时间(13.8±4.5)d分别介于激光袖套状包皮环切术组和包皮环环扎术组之间,3组比较差异均有统计学意义(P＜0.05).在术后并发症发生率和再次手术情况方面,传统包皮环切术组分别是0.7％(7/982)和0.2％ (2/982),激光袖套状包皮环切术组分别是4.9％(6/123)和0.8％(1/123),包皮环环扎术组分别是12.9％(16/142)和4.2％(6/142),3组手术方式对比差异也具有统计学意义(P＜0.05),传统包皮环切术组并发症及再次手术的发生率均最小.结论:激光袖套状包皮环切术手术耗时长、术后恢复期长、术后并发症多.包皮环环扎术手术耗时短、术后恢复快、不残留线头、外形美观,但感染率高,一旦感染伤口易裂开,必须控制感染后重新清创缝合.传统包皮环切术比较包皮环环扎术手术耗时、术后水肿消退期虽长,但术后并发症少,再次手术率低,较为安全可靠.     

包皮环切术的整形改进

目的:根据整形外科学原则对包皮环切术进行改进。方法:包皮环切过程中尽量减少对包皮系带的损伤,将包皮系带处的外板尖端修剪成圆钝弧形,缝合内外板时直接将出血点缝扎。结果:112 例患者均取得了良好效果,术后无出血,系带处水肿消除明显加快,系带感觉良好,包皮外形美观自然,部分病例随访 3～6 个月,性生活满意。结论:根据整形外科学原则对包皮环切术进行改进是非常必要且效果良好的。     

包皮切除器在包皮矫形术中的临床疗效观察

目的 探索包茎及包皮过长类疾病矫治的理想方法。方法 用自行设计的包皮切除器对包茎及包皮过长者施行矫治。结果 88例患者均于术后8.5d过长包皮自然枯死脱落，创缘愈合，随访3个月至5年，形态及功能满意。结论 该方法操作简单，创伤轻，无出血，疼痛轻，包皮创缘整齐美观，是矫治包皮过长的理想器械与方法。     

中国商环在成年男性包皮环切术中的应用效果观察

目的观察中国商环在包皮环切术的应用效果。方法 1 100例包皮患者均采用中国商环行包皮环切术。观察手术时间、术后出血、术后切口水肿、裂开、疼痛评分及切口愈合时间。结果 1 100例患者中顺利完成包皮环切术1 085例。手术时间为（5.0±1.0）min;出血量均少于5 ml;术后轻度水肿868例,中度水肿196例,重度水肿21例。术后无裂开213例,轻度裂开658例,中度裂开167例,重度裂开47例。术后24 h疼痛评分为（3.1±1.8）分,拆环时为（7.8±1.9）分;折环时疼痛评分明显大于术后24 h评分（P〈0.05）;愈合时间为（25.6±4.8）d。结论中国商环包皮环切术操作简单、手术时间短、出血少,但拆环时疼痛明显,术后切口水肿、裂开发生率高,切口愈合时间较长。     

冗余包皮增大慢性前列腺炎／慢性骨盆区疼痛综合征的发病可能

有证据表明包皮内板上存在着大量可以与病原体相互作用的抗原递呈细胞,这可能为病原体入侵机体提供了新的途径,而以往的研究中,病原体对慢性前列腺炎／慢性骨盆区疼痛综合征（CP／CPPS）如何发挥作用没有明确的结论,也没有相关的研究阐明包皮和CP／CPPS之间的关系。因此我们收集了322名CP／CPPS患者为病例组,并按年龄配对了341名对照组。统计了参与者的人口统计学资料、生活状态资料,以及入选者的包皮长度。应用多因素逻辑斯特回归分析来计算包皮长度对CP／CPPS的危险性。我们得出结论,与对照组相比,当包皮的长度超过阴茎头1／2后,包皮越长,CP／CPPS的风险越高。包皮覆盖小部分阴茎头时,不增31CP／CPPS的风险,包皮覆盖大部分阴茎头时,CP／CPPS的风险增高,OR为1．66（95％CI,1．04-2．66）,而包皮完全覆盖阴茎头时,OR上升到了1．86（95％CI,1．2-2．88）。导致这种结果的机制可能是病原体与包皮内板上的抗原递呈细胞相互作用,继而激活了T细胞介导的过敏性炎症反应,造成前列腺组织发生自身免疫作用。     

包皮环切术中成人包皮环切器内环内置与外置的比较

目的对比分析包皮环切术中环切器内环内置与内环外置的疗效和手术并发症。方法选择2011年4月至2012年4月间在我院就诊的包皮过长患者1211例作为研究对象,入选内环内置组（598例）,内环外置组（613例）,结合完整的随访数据,对比分析两组在手术时间、术中及术后3d疼痛程度、术中出血量、术后并发症发生率、包皮创口愈合时间、术后1个月外观满意率、总体费用以及术后性交时满意率、术后包皮水肿恢复时间方面的差异。结果在患者术中及术后3d疼痛程度、术后并发症发生率、包皮创口愈合时间方面,内环内置组均优于内环外置组。而对于手术时间、术中出血量、总体费用方面,两组之间无统计学差异。术后随访发现,两组在术后1个月外观满意率、术后1个月外观满意率、性交时满意度、包皮水肿恢复时间方面无统计学差异。结论内环内置法在保持常规操作方式优点的同时,更加有利于包皮创口的愈合、降低并发症和疼痛程度,是对成人包皮环切手术方式的改良,值得在临床上推广。     

Analysis of the effect of estrogen/androgen perturbation on penile development in transgenic and diethylstilbestrol‐Treated mice

Because both androgens and estrogens have been implicated in penile morphogenesis, we evaluated penile morphology in transgenic mice with known imbalance of androgen and estrogen signaling using scanning electron microscopy (SEM), histology, and immunohistochemistry of androgen and estrogen receptors α/β. Penises of adult wild‐type, estrogen receptor‐α knockout (αERKO), estrogen receptor‐β knockout (βERKO), aromatase knockout (Arom‐KO), and aromatase overexpression (Arom+) mice were evaluated, as well as adult mice treated with diethylstilbestrol (DES) from birth to day 10. Adult penises were examined because the adult pattern is the endpoint of development. The urethral orifice is formed by fusion of the MUMP (male urogenital mating protuberance) with the MUMP ridge, which consists of several processes fused to each other and to the MUMP. Similarly, the internal prepuce is completed ventrally by fusion of a ventral cleft. In adult murine penises the stromal processes that form the MUMP ridge are separated from their neighbors by clefts. αERKO, βERKO, and Arom‐KO mice have penises with a MUMP ridge clefting pattern similar to that of wild‐type mice. In contrast, Arom+ mice and neonatally DES‐treated mice exhibit profound malformations of the MUMP, MUMP ridge clefting pattern, and internal prepuce. Abnormalities observed in Arom+ and neonatally DES‐treated mice correlate with the expression of estrogen receptor‐beta (ERβ) in the affected structures. This study demonstrates that formation of the urethal orifice and internal prepuce is due to fusion of separate epithelial‐surfaced mesenchymal elements, a process dependent upon both androgen and estrogen signaling, in which ERβ signaling is strongly implicated. Anat Rec, 296:1127–1141, 2013. © 2013 Wiley Periodicals, Inc.