Huntley J S, Bourne M C, Munro F D, Wilson-Storey D
Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK.
J R Soc Med. 2003 Sep;96(9):449-51. doi: 10.1177/014107680309600908.
To assess the reasons for and outcomes of referrals concerning the foreskin, 100 consecutive patients seen in paediatric clinics were followed to discharge. 18 referrals were for circumcision on religious grounds. Of the other 82, the main reason for referral was non-retractability or phimosis. At clinic, 24 (29%) of these were deemed normal for age, 31 (38%) were treated with topical steroid (successfully in 25), 9 (11%) were listed for preputioplasty, 7 (9%) were listed for adhesiolysis, 7 (9%) were listed for circumcision, and 4 were listed for other forms of surgery. 6 patients were identified as having balanitis xerotica obliterans (BXO), a condition that had not been suggested on referral. With the advent of new treatments for foreskin disorders, circumcision is decreasingly necessary. Knowledge of the natural history of the foreskin, and the use of topical steroids, could shift the management of paediatric foreskin problems from the hospital outpatient department to primary care. BXO is not sufficiently recognized as a form of phimosis that requires operation.
为评估包皮转诊的原因及结果，对儿科门诊连续就诊的100例患者进行随访直至出院。18例转诊是出于宗教原因进行包皮环切术。在其他82例中，转诊的主要原因是包皮不能上翻或包茎。在门诊，其中24例（29%）被认为年龄上属正常，31例（38%）接受局部类固醇治疗（25例成功），9例（11%）被安排进行包皮成形术，7例（9%）被安排进行粘连松解术，7例（9%）被安排进行包皮环切术，4例被安排进行其他形式的手术。6例患者被确诊患有闭塞性干燥性龟头炎（BXO），这是一种转诊时未被提及的病症。随着包皮疾病新治疗方法的出现，包皮环切术的必要性日益降低。了解包皮的自然病程以及使用局部类固醇，可能会将小儿包皮问题的管理从医院门诊部转移至初级保健机构。BXO作为一种需要手术治疗的包茎形式，尚未得到充分认识。
