包(bao)(bao)(bao)(bao)莖(jing)(jing)(jing)指包(bao)(bao)(bao)(bao)皮(pi)(pi)(pi)口狹(xia)小,不能(neng)上(shang)(shang)翻露出陰莖(jing)(jing)(jing)頭(tou)。包(bao)(bao)(bao)(bao)莖(jing)(jing)(jing)分為先(xian)天(tian)性包(bao)(bao)(bao)(bao)莖(jing)(jing)(jing)和后天(tian)性包(bao)(bao)(bao)(bao)莖(jing)(jing)(jing)。包(bao)(bao)(bao)(bao)皮(pi)(pi)(pi)內板與陰莖(jing)(jing)(jing)頭(tou)表(biao)面輕(qing)度的上(shang)(shang)皮(pi)(pi)(pi)粘連被吸收,包(bao)(bao)(bao)(bao)皮(pi)(pi)(pi)退(tui)縮,陰莖(jing)(jing)(jing)頭(tou)外露。若(ruo)粘連未(wei)被吸收,就形(xing)成了先(xian)天(tian)性包(bao)(bao)(bao)(bao)莖(jing)(jing)(jing)。后天(tian)性包(bao)(bao)(bao)(bao)莖(jing)(jing)(jing)多繼(ji)發(fa)于陰莖(jing)(jing)(jing)頭(tou)包(bao)(bao)(bao)(bao)皮(pi)(pi)(pi)炎癥,使包(bao)(bao)(bao)(bao)皮(pi)(pi)(pi)口形(xing)成瘢痕性攣縮。若(ruo)包(bao)(bao)(bao)(bao)莖(jing)(jing)(jing)嚴重,可(ke)(ke)引起排尿(niao)困難甚至尿(niao)潴留。包(bao)(bao)(bao)(bao)皮(pi)(pi)(pi)垢積累(lei)時,可(ke)(ke)有陰莖(jing)(jing)(jing)頭(tou)刺癢感。長期(qi)慢性刺激,可(ke)(ke)誘發(fa)感染與癌變,白斑病及(ji)結石。
先天性(xing)(xing)包(bao)(bao)莖(jing)因(yin)新生兒包(bao)(bao)皮與陰(yin)莖(jing)頭存有(you)生理性(xing)(xing)自然(ran)粘連。后天性(xing)(xing)包(bao)(bao)莖(jing)多繼發于(yu)陰(yin)莖(jing)頭包(bao)(bao)皮炎癥,使包(bao)(bao)皮口形(xing)成瘢痕性(xing)(xing)攣縮。
包(bao)(bao)皮(pi)(pi)(pi)(pi)口狹(xia)小(xiao),呈針孔樣,可(ke)(ke)引起(qi)不(bu)同程度的排(pai)(pai)尿困(kun)難(nan),尿流緩慢、細小(xiao),排(pai)(pai)尿時(shi)(shi)包(bao)(bao)皮(pi)(pi)(pi)(pi)膨起(qi)。包(bao)(bao)皮(pi)(pi)(pi)(pi)不(bu)能翻起(qi)清洗,包(bao)(bao)皮(pi)(pi)(pi)(pi)囊(nang)內積聚包(bao)(bao)皮(pi)(pi)(pi)(pi)垢,包(bao)(bao)皮(pi)(pi)(pi)(pi)垢可(ke)(ke)從包(bao)(bao)皮(pi)(pi)(pi)(pi)口排(pai)(pai)出,亦可(ke)(ke)呈小(xiao)塊狀(zhuang)存留于陰(yin)(yin)莖(jing)頭冠狀(zhuang)溝(gou)部。包(bao)(bao)皮(pi)(pi)(pi)(pi)垢存留,尿液排(pai)(pai)出不(bu)暢,容(rong)易發(fa)生(sheng)包(bao)(bao)皮(pi)(pi)(pi)(pi)陰(yin)(yin)莖(jing)頭炎。包(bao)(bao)皮(pi)(pi)(pi)(pi)陰(yin)(yin)莖(jing)頭炎癥時(shi)(shi)包(bao)(bao)皮(pi)(pi)(pi)(pi)口紅(hong)腫,有膿性分泌物(wu)。嵌頓性包(bao)(bao)莖(jing),疼痛劇烈,包(bao)(bao)皮(pi)(pi)(pi)(pi)水腫,在其上緣可(ke)(ke)見到狹(xia)窄(zhai)環(huan),陰(yin)(yin)莖(jing)頭呈暗紫色。有排(pai)(pai)尿困(kun)難(nan),長時(shi)(shi)間(jian)嵌頓可(ke)(ke)發(fa)生(sheng)包(bao)(bao)皮(pi)(pi)(pi)(pi)和龜頭壞死。
1.包(bao)皮(pi)過長、外口(kou)狹小、不(bu)能翻起、使陰莖頭(tou)不(bu)能裸露者為包(bao)莖。因(yin)屢發(fa)包(bao)皮(pi)陰莖頭(tou)炎,致二(er)者粘連使包(bao)皮(pi)不(bu)能上翻、陰莖頭(tou)不(bu)能裸露者為繼發(fa)包(bao)莖。
2.包莖(jing)之(zhi)外口較小,偶爾勉強將(jiang)包皮上翻至冠(guan)狀溝區,并嵌頓(dun)于該(gai)處不能下(xia)翻者(zhe)為(wei)嵌頓(dun)包莖(jing)。歷時稍久,嵌頓(dun)環遠(yuan)端(duan)之(zhi)包皮發生明(ming)顯水腫(zhong)甚至壞死,嚴重者(zhe)可影響(xiang)排尿(niao)。
1.包皮過長
包莖是指(zhi)包皮(pi)不(bu)能翻動,包皮(pi)口狹(xia)小,包皮(pi)過(guo)長則可用手(shou)把包皮(pi)翻開,讓龜頭露出來(lai)。
2.隱匿陰莖
患兒(er)肥胖,包(bao)皮呈鳥嘴(zui)狀(zhuang),陰莖(jing)(jing)(jing)皮膚不附著于陰莖(jing)(jing)(jing)體(ti),陰莖(jing)(jing)(jing)擠壓試驗(yan)陽性。
可(ke)使包(bao)皮(pi)龜頭黏膜水腫(zhong)、充血、糜爛、反復交叉(cha)感染,形(xing)成包(bao)皮(pi)龜頭炎、包(bao)皮(pi)粘(zhan)連、包(bao)皮(pi)結石,甚至發生(sheng)包(bao)皮(pi)嵌頓,導致包(bao)皮(pi)龜頭壞死等嚴(yan)重(zhong)后果,同(tong)時(shi)還可(ke)通過夫(fu)妻性生(sheng)活將多種病(bing)菌帶入女(nv)性體內,導致女(nv)性陰道炎、宮(gong)(gong)頸(jing)炎、宮(gong)(gong)頸(jing)糜爛、盆腔炎、子宮(gong)(gong)內膜炎、宮(gong)(gong)頸(jing)癌等疾病(bing)的發生(sheng)。
1.嬰(ying)幼兒期的先天性(xing)包(bao)(bao)(bao)(bao)莖(jing)(jing),可(ke)將包(bao)(bao)(bao)(bao)皮反復(fu)試行上翻,以(yi)便擴大包(bao)(bao)(bao)(bao)皮口。手(shou)法要輕(qing)柔,不可(ke)過分急(ji)于(yu)把包(bao)(bao)(bao)(bao)皮退縮上去。當陰莖(jing)(jing)頭露出后,清(qing)潔包(bao)(bao)(bao)(bao)皮垢,涂(tu)抗生(sheng)素藥膏(gao)或液狀石(shi)蠟使其潤滑(hua),然后將包(bao)(bao)(bao)(bao)皮復(fu)原,否則會造成嵌(qian)頓包(bao)(bao)(bao)(bao)莖(jing)(jing)。大部分小兒經此種(zhong)方法治療,隨年齡增長均可(ke)治愈,只(zhi)有(you)少數(shu)需(xu)(xu)做包(bao)(bao)(bao)(bao)皮環切術,對于(yu)包(bao)(bao)(bao)(bao)皮嵌(qian)頓,需(xu)(xu)緊急(ji)施行手(shou)法復(fu)位,必(bi)要時做包(bao)(bao)(bao)(bao)皮背側(ce)切開。
2.后天性包(bao)莖(jing)患者由于其包(bao)皮(pi)口(kou)(kou)呈纖(xian)(xian)維狹(xia)窄(zhai)環(huan)(huan),需行包(bao)皮(pi)環(huan)(huan)切術,適應證如下:①包(bao)皮(pi)口(kou)(kou)有纖(xian)(xian)維性狹(xia)窄(zhai)環(huan)(huan)。②反復發作陰(yin)莖(jing)頭(tou)包(bao)皮(pi)炎。③6歲以后包(bao)皮(pi)口(kou)(kou)狹(xia)窄(zhai)。
對于包(bao)皮(pi)(pi)(pi)(pi)環切(qie)(qie)術的適應證(zheng)說法不(bu)一,有(you)些國家及地(di)區因宗教或民(min)族(zu)習慣,出生(sheng)后常(chang)規做包(bao)皮(pi)(pi)(pi)(pi)環切(qie)(qie)。有(you)人認為包(bao)皮(pi)(pi)(pi)(pi)環切(qie)(qie)可(ke)減(jian)少陰莖(jing)癌(ai)與婚(hun)后女性宮頸癌(ai)的發病(bing)率(lv)(lv)。但(dan)有(you)資料說明(ming),常(chang)規做包(bao)皮(pi)(pi)(pi)(pi)環切(qie)(qie)的以色(se)列(lie)與包(bao)皮(pi)(pi)(pi)(pi)環切(qie)(qie)術不(bu)普及的北歐國家,這兩種(zhong)癌(ai)的發病(bing)率(lv)(lv)均很低,無(wu)顯著(zhu)差異。
近年來,包皮(pi)環(huan)切術(shu)的術(shu)式(shi)也有了很大的改進,如袖套式(shi)包皮(pi)環(huan)切術(shu),損傷更(geng)小(xiao),恢復(fu)更(geng)快(kuai),更(geng)易為(wei)患者(zhe)接受。一般主張在3歲以后進行。
1.未施(shi)行包(bao)(bao)皮環切手術(shu)時,護理上注意陰莖局(ju)部的清(qing)潔衛生(sheng),經常(chang)洗(xi)滌,如(ru)包(bao)(bao)皮不(bu)能翻(fan)起,不(bu)要強(qiang)行翻(fan)轉。如(ru)能翻(fan)起清(qing)洗(xi),洗(xi)畢要將包(bao)(bao)皮恢復(fu)到原來的位置,以(yi)免造成嵌頓性(xing)包(bao)(bao)莖。
2.如(ru)施行包皮環切手,手術前(qian)3天要用(yong)溫開水(shui)清(qing)洗陰莖部。手術后除了注(zhu)意上述用(yong)藥,防止陰莖勃起出血和發(fa)炎外,還應(ying)注(zhu)意包扎敷料的(de)干(gan)燥,萬一被尿液(ye)浸濕應(ying)及時更換(huan),一般術后5~7日拆線。