摘要
目的探讨儿童病理性包茎的临床特点,并分析其与干燥闭塞性阴茎头炎(BXO)的关系。方法回顾性分析2018年7月至2022年8月因病理性包茎于海南省人民医院行包皮环切术的45例患儿的临床资料。患儿包皮口均呈瘢痕包茎改变,颜色苍白、增厚、僵硬、弹性差;术后瘢痕包皮病理均明确诊断为病理性包茎。根据病理检查结果分组,硬化萎缩性苔藓样变患者为BXO组,其他病理类型(慢性炎症、非典型改变、扁平苔藓样变)患者为非BXO组。对比分析两组的发病年龄、病史及伴随症状。记录尿道狭窄情况及类固醇激素的使用情况。结果BXO组33例,年龄(7.42±2.46)岁,其中5~11岁占91%(30/33);非BXO组12例,年龄(10.42±2.88)岁,两组年龄差异有统计学意义(P<0.05)。BXO组与非BXO组中既往有阴茎头包皮炎病史(28例与7例)、有包皮扩张史(15例与3例),以及尿频(18例与10例)、尿急(12例与4例)、尿痛(17例与3例)、排尿困难(21例与5例)、瘙痒(25例与7例)、阴茎疼痛(7例与1例)、排尿鼓包(7例与6例)、尿流分散(14例与2例)症状的差异均无统计学意义(P>0.05)。8例尿道狭窄均出现在BXO组,其中3例术中即发现尿道口严重狭窄,行尿道扩张后留置硅胶导尿管5~10 d,术后第3天开始局部用类固醇激素治疗;4例术中发现尿道口部分受累,术中未予特殊处理,术后尿线细;1例术中未发现尿道口异常,术后2周发现尿道口狭窄。BXO组患者均在病理确诊LS后局部使用类固醇激素。4例尿道口部分受累病例中3例用药后尿线逐渐增粗;1例尿线细改善不明显,分别在术后3、6周两次行尿道扩张术。术后随访12.2(5.4,21.8)个月,患儿均恢复顺利,尿道狭窄患儿尿线改善至与同龄儿相当,且尿流方向与阴茎长轴方向一致。结论BXO是男童病理性包茎的主要原因,其诊断以组织病理为准。年龄较小的病理性包茎患儿,诊断BXO的可能性更大;BXO的主要并发症为尿道狭窄,临床上需尽早发现,及时治疗。
Objective To investigate the clinical characteristics of pathological phimosis and analyze the correlation between pathological phimosis and balanitis xerotica obliterans(BXO)in children.Methods The clinical data of 45 children who underwent circumcision and histopathologic evaluation in our hospital from July 2018 to August 2022 were retrospectively analyzed.According to the results of the pathological examination,lichen sclerosis et atrophicus cases were classified as the BXO group,and other cases were classified as the non-BXO group.The two groups'age,history,and symptoms were recorded and compared.The management of meatal stenosis and the effect of topical steroids were described.Results There were 33 patients in the BXO group,aged(7.42±2.46)years old,of which 91%(30/33)were 5-11 years old.There were 12 patients in the non-BXO group,aged(10.42±2.88)years old.The difference of age between the two groups was statistically significant(P<0.05).But there was no significant difference between the BXO group and non-BXO group in the history of balanoposthitis(28 cases vs.7 cases),history of foreskin dilated(15 cases vs.3 cases),frequent urination(18 cases vs.10 cases),urgent urination(12 cases vs.4 cases),urination pain(17 cases vs.3 cases),dysuria(21 cases vs.5 cases),pruritus(25 cases vs.7 cases),penile pain(7 cases vs.1 case),ballooning(7 cases vs.6 cases),and spraying(14 cases vs.2 cases)(P>0.05).All 8 cases of meatal stenosis were in the BXO group.Three cases underwent meatal dilatation and indwelling catheter was left for 5-10 days,and topical steroid was used on the third day after surgery.The remaining cases were treated with topical steroids after a pathological diagnosis of BXO.Among the 4 cases with partial urethral meatus involvement,3 had good results after treatment,and 1 had no significant improvement and underwent meatal dilatation twice later.In 1 case,meatal stenosis was found two weeks after surgery,but no meatal abnormality was found during operation.All patients recovered smoothly during a median follow-up of 12.2(5.4,21.8)months.Conclusions BXO is the main cause of pathologic phimosis in boys,and the diagnosis is based on histopathology.The main complication of BXO is meatal stenosis,which should be detected as early as possible and treated in time.
作者
王玉芸
林海
Wang Yuyun;Lin Hai(Department of Pediatric Surgery,Hainan General Hospital,Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2023年第7期529-532,共4页
Chinese Journal of Urology
