矫正包皮过长的新观念

New concept of the treatment for redundant prepuce

目的复习有关包皮发育及包皮功能的文献，探讨白阴茎根部环行切除多余皮肤和传统包皮环切方法的优点与缺点，并选择一种最佳的手术方法和手术时机治疗包皮过长。方法确切测量阴茎的牵拉长度和阴茎皮肤的牵拉长度后，白阴茎根部环行切除阴茎多余的皮肤，利用阴茎皮肤具有滑动的特性将余下的阴茎皮肤向阴茎根部拉拢缝合，达到治疗单纯阴茎皮肤过长的目的。对于有包皮外口狭窄的患者，先在狭窄环处纵行切开狭窄环后横行缝合，解除外口狭窄后再白阴茎根部切除多余的阴茎皮肤。结果2002年10月至2006年10月共治疗110例单纯包皮过长和40例伴包皮外口狭窄的包皮过长患者，手术后术区疼痛轻微，包皮外观自然，患者对手术效果均感觉满意。结论治疗包皮过长的手术方式以从根部环行切除多余的阴茎皮肤为佳，且应待患者包皮发育成熟（大多在17岁）后再行手术治疗，包皮发育过程中如果有包茎、包皮粘连等情况时，应该给予非手术的保守治疗。

Objective Literatures on the development and function of prepuce was reviewed. To compare the merit and demerit of treatment for redundant prepuce by conventional circumcision or by removing the root skin of the penis. To investigate the ideal method and time of treatment for redundant prepuce. Methods The extended length of the penis and the extended skin of penis were carefully measured and the excess skin at the root of the penis was removed from the surface of Colle＇ s fascia. Then the remaining distal skin was drew back to suture to the root of the penis. As for the cases complicated with stenosis of prepuce, longitudinal incision was pedormed along the constricted area to release stenosis, followed by transverse closure of the wound. Results 110 adult cases of simple redundant prepuce and 40 cases complicated with stenosis were treated by this way. Functional and cosmetic results were achieved without any complications in all cases. All patients were satisfied with the result. Conclusions Removal of the excess skin at the root of the penis should be preferred to the conventional circumcision for treatment of redundant prepuce. The ideal time for intervention is at or after adolescence, when the prepuce has developed maturely. Non - operative methods should be taken to treat phimosis and adherent prepuce before adolescence.