包茎、包皮过长术式选择3000例临床研究

Clinical Research of 3000 Cases on Phimosis, Prepuce Surgical Options

目的:探讨传统包皮环切术和新型环切法(又称包皮套环法、包皮环扎法)治疗包茎、包皮过长术式选择和临床疗效。方法:回顾性分析本院外科采用传统环切法(500例)和新型环切法(又称套环法、环扎法)(2500例)治疗包茎或包皮过长共计3000例患者的临床资料,比较两种术式手术时间、术中出血量、术后疼痛与不适时间、术者和患者对手术满意程度、术后并发症、愈合时间、包皮水肿、患者对术后外观满意度。结果:显示新型环切法(套环法)手术简单耗时短、极少出血无须止血。术后伤口出血极少25例(占1%),无线结、无须换药拆线、次日可洗澡、边沿整齐等方面优于传统环切法手术(P<0.05)。术后偶有包皮龟头粘连及嵌顿50例(占2%)。适应儿童。传统环切法手术繁琐费时、有出血需止血。术后伤口偶有血肿10例(占2%)、残留止血线结、需要来院换药拆线、边沿不整齐,不能洗澡。术后不发生包皮龟头粘连及嵌顿优于套环法,适应成年人。结论:两种术式各有优缺点,笔者认为对于包皮过长、包茎传统环切法较适应成年人。新型环切法(套环法)较适应儿童。术式选择还要根据手术者对不同术式的手术技巧、手术熟练程度和患者的要求等方面考虑。

Objective： To investigate options and clinical efficacy of phimosis, prepuce surgical using traditional and new circumcision act.Method： The clinical data of 3000 patients were retrospectively analyzed, they used the traditional method（n=500） and a new ring-cut method（n=2500） treatment of phimosis or prepuce in our hospital. Then the two methods including the operative time, blood loss, postoperative pain and discomfort time, the surgeon and patient satisfaction with surgery, postoperative complications, healing time, the foreskin edema, the patient satisfaction with postoperative appearance degrees were compared. Result： New circumcision spended short time, accompanied by less bleeding. There were 25 cases of postoperative wound bleeding（1%）, but had no knot. Patients didn＇t need dressing and stitches and could take a bath. 50 cases happened adhesions and incarcerated of Foreskin and glans after surgery. This surgery was adapted to child. Traditional circumcision wasted of time and was easy bleeding. There were 10 cases of postoperative wound hematoma（2%）, residual bleeding knot. Edges of the incision was irregular. Patients needed dressing and stitches and could not take a bath. Adhesions and incarcerated of Foreskin and glans didn＇t happen after surgery. This surgery was adapted to adult. Conclusion： The traditional circumcision is adapted to adult and the new circumcision is adapted to child for phimosis and prepuce. Surgical options should also be considered according to the different surgical techniques, surgical proficiency, the patient＇s request and so on.