儿童干燥闭塞性阴茎头炎8例及文献复习

Balanitis xerotica obliterans in boys: a report of 8 cases and literature review

目的探讨干燥闭塞性阴茎龟头炎(Balanitis xerotica obliterans,BXO)在儿童期的临床特点、发病机制、诊治特点及预后。以进一步加深对该病的认识和重视,提高临床疗效并改善预后。方法回顾性分析2014年10月至2017年10月间我们收治的8例BXO患儿临床资料。同时对相关文献进行回顾总结。结果入选病例均通过临床表现诊断BXO,其中2例经病理诊断证实。患儿年龄2~10岁,平均年龄为7.4岁。均以"包茎、包皮口瘢痕狭窄"就诊,临床表现为排尿不畅或伴排尿后滴血,无明显的阴茎包皮感染病史,除1例术前彩超提示膀胱壁增厚外,其余均未见异常。查体见包皮内板及龟头呈不同程度增厚变白、硬化,部分包皮内板与冠状沟处及系带粘连严重。均予包皮环切和或系带成形术。术后1例出现尿道外口膜状狭窄,经反复尿道扩张及激素局部治疗,半年后症状无缓解,失访;其余7例排尿正常,阴茎包皮及龟头皮肤损害均消失;1例术后诊断为"过敏性紫癜"。结论BXO在儿童阴茎疾病中并不少见,常由于认识不足,导致延误诊断,错过及时准确治疗。重视病史、体检及继发性包茎术后包皮的病理检查,做好早期诊治和术后随访管理,有利于避免术后尿道狭窄及不必要的医疗纠纷。

Objective To explore the clinical characteristics, pathogenesis, diagnosis, treatment andprognosis of balanitis xerotica obliterans （BXO） in boys. Methods The clinical data of 8 BXO boys were retrospectively analyzed between 2014 and 2017 along with a review of the relevant literature. Results A definitediagnosis was based upon clinical features and pathological examination. The mean age was 7. 4（2 - 10） years.All of them were diagnosed as phimosis or foreskin scars. The major clinical symptoms included intermittent urination or blood dripping at the end of urination and there was a history of nonspecific chronic inflammation.Only 1 case had positive finding on urological ultrasound. Physical examination revealed that foreskin had whitescar and become nonretractable and foreskin plate and coronal groove had severe adhesion. Complete circumcision and / or frenoplasty was performed. After operation,except for 1 case of meatal stenosis and lost to followup,the remainder were cured and had normal urination,foreskin and glans. One case was finally diagnosed asallergic purpura. Conclusion BXO is much more common in boys than previous ly assumed. Timely and accurate diagnosis and treatment are crucial for a better prognosis. Collecting medical history and emphasizing physical and histopathological examination of secondary phimosis are important. Proper education and close followups prevent the occurrence of postoperative complications.