手法扩张分离法治疗小儿包茎合并包皮粘连

目的探讨小儿包茎合并包皮粘连的治疗方法。方法采用手法渐行扩张包皮口并手法分离包皮粘连的方法治疗小儿包茎合并包皮粘连，并在龟头及包皮内板上均匀涂上红霉素软膏，术后每天用红霉素软膏涂龟头3．5次，4～7d后复查，龟头发红消退后停止涂药。此后注意经常上翻包皮清洗。结果400例患儿术后4～7d，包皮龟头无红肿，包皮能轻松自如上翻，冠状沟、包皮系带完全暴露，尿线大小正常，小便时无包皮鼓起，且创面愈合无瘢痕或结痂，治愈率为100％。所有患儿随访24个月，均无包皮、龟头及尿道外口红肿，包皮垢均消失，尿线正常，外生殖器无不适感，包皮上翻自如。结论手法扩张包皮外口并手法分离包皮内板与龟头粘连的方法治疗小儿包茎合并包皮粘连效果佳，简单、安全，适宜推广应用。

Manual dilation and separation techniques in the treatment of phimosis combining with foreskin adhesion in children

Objective To explore the therapeutic methods of phimosis combining with foreskin adhesion in children. Methods The techniques of manual gradual expansion of preputial orifice and separation of foreskin adhesion were applied to treat phimosis on the combination of foreskin adhesion in children. After that, erythromycin ointment was evenly covered on glans penis and inner plate of prepuce, which was used 3 to 5 times each day after surgery. Reexamination was in 4 to 7 days, and ointment was stopped after redness of glans penis disappeared gradually. Since then, it was noticed that the foreskin should be frequently turned up and washed. Results A total of 400 children patients, 4 to 7 days after surgery, presented with no swelling in glans penis which could be turned up easily and freely, com- pletely exposed coronary sulcus and frenulum of prepuce, normal size of urine stream, and no bulge of foreskin on urination. What＇s more, there was no scar or scab in wound healing with 100% cure rate. During two-year follow-up, there was no swelling in foreskin, glans penis, or external urethral orifice and no discomfort in external genitalia. The smegma praeputii all disappeared, urine stream became normal and foreskin could freely turn up. Conclusion The simple and safe techniques of manual expansion preputial orifice and manual separation of inner plate of prepuce and glans penis adhesion obtain optimum effects in the treatment of phimosis combining with foreskin adhesion in children, which are worthy of extension in clinic.