包(bao)(bao)(bao)莖(jing)(jing)指(zhi)包(bao)(bao)(bao)皮(pi)(pi)口狹小,不能上(shang)翻露出陰(yin)莖(jing)(jing)頭。包(bao)(bao)(bao)莖(jing)(jing)分為(wei)先天性(xing)(xing)(xing)(xing)包(bao)(bao)(bao)莖(jing)(jing)和后(hou)天性(xing)(xing)(xing)(xing)包(bao)(bao)(bao)莖(jing)(jing)。包(bao)(bao)(bao)皮(pi)(pi)內板與陰(yin)莖(jing)(jing)頭表(biao)面輕度(du)的上(shang)皮(pi)(pi)粘(zhan)連被吸收(shou),包(bao)(bao)(bao)皮(pi)(pi)退(tui)縮,陰(yin)莖(jing)(jing)頭外露。若粘(zhan)連未被吸收(shou),就(jiu)形成了先天性(xing)(xing)(xing)(xing)包(bao)(bao)(bao)莖(jing)(jing)。后(hou)天性(xing)(xing)(xing)(xing)包(bao)(bao)(bao)莖(jing)(jing)多繼發于陰(yin)莖(jing)(jing)頭包(bao)(bao)(bao)皮(pi)(pi)炎癥,使包(bao)(bao)(bao)皮(pi)(pi)口形成瘢痕性(xing)(xing)(xing)(xing)攣縮。若包(bao)(bao)(bao)莖(jing)(jing)嚴重,可(ke)(ke)引起(qi)排(pai)尿困(kun)難甚至尿潴留(liu)。包(bao)(bao)(bao)皮(pi)(pi)垢積累時,可(ke)(ke)有(you)陰(yin)莖(jing)(jing)頭刺癢感。長期慢性(xing)(xing)(xing)(xing)刺激,可(ke)(ke)誘發感染與癌(ai)變,白斑病(bing)及結石(shi)。
先天性包莖因新生(sheng)兒(er)包皮(pi)與陰(yin)莖頭存(cun)有生(sheng)理性自(zi)然粘連。后(hou)天性包莖多(duo)繼(ji)發(fa)于(yu)陰(yin)莖頭包皮(pi)炎癥(zheng),使包皮(pi)口形成瘢痕性攣縮。
包(bao)皮(pi)(pi)(pi)(pi)口(kou)狹(xia)小,呈(cheng)(cheng)針孔樣(yang),可(ke)(ke)引(yin)起不同程度(du)的排(pai)尿(niao)困難,尿(niao)流緩(huan)慢(man)、細(xi)小,排(pai)尿(niao)時(shi)包(bao)皮(pi)(pi)(pi)(pi)膨起。包(bao)皮(pi)(pi)(pi)(pi)不能(neng)翻起清洗,包(bao)皮(pi)(pi)(pi)(pi)囊內積聚包(bao)皮(pi)(pi)(pi)(pi)垢,包(bao)皮(pi)(pi)(pi)(pi)垢可(ke)(ke)從包(bao)皮(pi)(pi)(pi)(pi)口(kou)排(pai)出,亦可(ke)(ke)呈(cheng)(cheng)小塊狀(zhuang)存(cun)留于陰(yin)莖(jing)頭冠狀(zhuang)溝部。包(bao)皮(pi)(pi)(pi)(pi)垢存(cun)留,尿(niao)液排(pai)出不暢,容易發生包(bao)皮(pi)(pi)(pi)(pi)陰(yin)莖(jing)頭炎(yan)。包(bao)皮(pi)(pi)(pi)(pi)陰(yin)莖(jing)頭炎(yan)癥時(shi)包(bao)皮(pi)(pi)(pi)(pi)口(kou)紅(hong)腫,有(you)膿性(xing)分泌物。嵌頓(dun)性(xing)包(bao)莖(jing),疼痛劇(ju)烈,包(bao)皮(pi)(pi)(pi)(pi)水腫,在其上緣可(ke)(ke)見到狹(xia)窄環,陰(yin)莖(jing)頭呈(cheng)(cheng)暗(an)紫色。有(you)排(pai)尿(niao)困難,長(chang)時(shi)間嵌頓(dun)可(ke)(ke)發生包(bao)皮(pi)(pi)(pi)(pi)和(he)龜(gui)頭壞死。
1.包(bao)皮(pi)過(guo)長、外口狹小、不(bu)能翻起、使陰(yin)莖頭(tou)不(bu)能裸(luo)(luo)露者為包(bao)莖。因(yin)屢發包(bao)皮(pi)陰(yin)莖頭(tou)炎,致(zhi)二者粘連使包(bao)皮(pi)不(bu)能上翻、陰(yin)莖頭(tou)不(bu)能裸(luo)(luo)露者為繼發包(bao)莖。
2.包莖之外口較小,偶爾勉強(qiang)將包皮(pi)上翻至冠(guan)狀(zhuang)溝區,并嵌頓(dun)于(yu)該處不能下翻者(zhe)為嵌頓(dun)包莖。歷時稍(shao)久,嵌頓(dun)環遠端(duan)之包皮(pi)發生明顯水腫甚至壞死,嚴重者(zhe)可影響排尿。
1.包皮過長
包(bao)(bao)莖是指包(bao)(bao)皮不能翻動,包(bao)(bao)皮口(kou)狹(xia)小,包(bao)(bao)皮過長則可用(yong)手(shou)把包(bao)(bao)皮翻開,讓(rang)龜(gui)頭露出(chu)來。
2.隱匿陰莖
患兒肥(fei)胖(pang),包(bao)皮呈鳥嘴(zui)狀,陰(yin)莖皮膚不附著于陰(yin)莖體,陰(yin)莖擠壓試驗陽性。
可(ke)使包(bao)(bao)(bao)皮(pi)(pi)龜(gui)(gui)頭(tou)黏膜水腫、充血、糜爛、反復(fu)交叉感染(ran),形成(cheng)包(bao)(bao)(bao)皮(pi)(pi)龜(gui)(gui)頭(tou)炎、包(bao)(bao)(bao)皮(pi)(pi)粘連、包(bao)(bao)(bao)皮(pi)(pi)結石,甚(shen)至發生(sheng)包(bao)(bao)(bao)皮(pi)(pi)嵌頓,導致包(bao)(bao)(bao)皮(pi)(pi)龜(gui)(gui)頭(tou)壞死等嚴(yan)重后果(guo),同(tong)時還可(ke)通(tong)過夫妻性(xing)生(sheng)活將多(duo)種病菌帶入女(nv)性(xing)體內(nei),導致女(nv)性(xing)陰(yin)道(dao)炎、宮頸(jing)炎、宮頸(jing)糜爛、盆(pen)腔炎、子宮內(nei)膜炎、宮頸(jing)癌等疾病的發生(sheng)。
1.嬰幼兒(er)期的(de)先天性包莖,可將(jiang)包皮(pi)(pi)反復(fu)試行(xing)上翻,以便擴大包皮(pi)(pi)口。手法要輕(qing)柔,不可過(guo)分急于把包皮(pi)(pi)退(tui)縮上去。當陰莖頭露出后(hou)(hou),清潔(jie)包皮(pi)(pi)垢,涂(tu)抗生素藥膏或液狀石蠟使其(qi)潤滑,然后(hou)(hou)將(jiang)包皮(pi)(pi)復(fu)原,否則會(hui)造成(cheng)嵌頓包莖。大部(bu)分小兒(er)經此種方法治療,隨年齡增長均(jun)可治愈,只(zhi)有(you)少數需做包皮(pi)(pi)環切術,對于包皮(pi)(pi)嵌頓,需緊急施行(xing)手法復(fu)位,必要時(shi)做包皮(pi)(pi)背側切開。
2.后天性包(bao)(bao)莖(jing)患者由于(yu)其(qi)包(bao)(bao)皮(pi)口呈纖(xian)維狹窄(zhai)(zhai)環,需行包(bao)(bao)皮(pi)環切術,適應證如下(xia):①包(bao)(bao)皮(pi)口有纖(xian)維性狹窄(zhai)(zhai)環。②反復發作陰莖(jing)頭包(bao)(bao)皮(pi)炎。③6歲以后包(bao)(bao)皮(pi)口狹窄(zhai)(zhai)。
對于包(bao)皮(pi)(pi)環切(qie)(qie)術的(de)適應證說(shuo)法不(bu)一,有(you)(you)些國(guo)家及地區因宗教或民族習慣(guan),出生后(hou)常規做包(bao)皮(pi)(pi)環切(qie)(qie)。有(you)(you)人(ren)認為包(bao)皮(pi)(pi)環切(qie)(qie)可減少陰莖癌與婚后(hou)女性(xing)宮頸癌的(de)發病率(lv)。但有(you)(you)資料說(shuo)明,常規做包(bao)皮(pi)(pi)環切(qie)(qie)的(de)以色列與包(bao)皮(pi)(pi)環切(qie)(qie)術不(bu)普及的(de)北歐(ou)國(guo)家,這(zhe)兩種癌的(de)發病率(lv)均很低,無(wu)顯(xian)著差異(yi)。
近年來,包皮(pi)環切術的術式(shi)也有了很大的改進(jin),如袖套(tao)式(shi)包皮(pi)環切術,損傷更(geng)小,恢復更(geng)快,更(geng)易(yi)為(wei)患者(zhe)接受(shou)。一般(ban)主張在3歲(sui)以后進(jin)行(xing)。
1.未(wei)施行(xing)包皮(pi)環切手(shou)術時,護(hu)理上(shang)注意陰莖局部的清(qing)(qing)潔衛(wei)生,經(jing)常洗(xi)(xi)滌,如(ru)包皮(pi)不(bu)能翻起(qi),不(bu)要強(qiang)行(xing)翻轉。如(ru)能翻起(qi)清(qing)(qing)洗(xi)(xi),洗(xi)(xi)畢要將包皮(pi)恢復(fu)到原來的位置,以免造成(cheng)嵌頓性包莖。
2.如(ru)施行包(bao)皮環切手,手術(shu)前3天要用溫開水清洗陰莖(jing)部。手術(shu)后除了注(zhu)意上(shang)述用藥,防止陰莖(jing)勃起(qi)出血和發炎外,還應注(zhu)意包(bao)扎敷料的干燥,萬一被尿液浸濕應及時更換(huan),一般術(shu)后5~7日拆線。