摘要
目的：探讨阴茎大部分缺损的有效修复方法。方法：通过尸体解剖，了解阴茎悬韧带的厚度、阴茎脚剥离长度与稳定性的关系。通过超声影像了解正常人阴茎根部血管走向以及阴茎深动脉进入海绵体的长度。对40例阴茎短小病例行扩大的阴茎海绵体延伸术、龟头和冠状沟塑形术。修复术中通过离断阴茎浅、深悬韧带，并继续分离部分海绵体脚，使原固定于耻骨下支的阴茎海绵体充分分离，以使阴茎更为延伸；用含血运的脂肪瓣填塞耻骨前间隙，保证术后远期阴茎的有效长度；选用合适的带血管蒂皮瓣转移覆盖海绵体，塑造更为逼真的龟头和冠状沟样外形。阴茎修复术后取材移植皮瓣全层皮肤，分别进行光镜、免疫组化、透射电镜和扫描电镜检测，观察皮肤神经再生情况；通过感觉功能的检测了解阴茎感觉功能恢复情况；采用夜间阴茎勃起测定系统检测修复阴茎勃起功能。结果：经30例60侧尸体解剖发现，阴茎浅悬韧带前缘至阴茎深悬韧带后缘平均7.66cm。放射影像学造影显示阴茎海绵体在耻骨联合下份分开，两侧海绵体脚分别附着于耻骨下支，末端达耻骨下支中份。超声影像学检测14例正常健康男性，显示阴茎根部至阴茎深动脉进入海绵体处的长度平均6.6cm。临床修复阴茎40例，术前残留阴茎常态下长度0.5～4.0 cm，勃起时长度2.0～6.0
Objective:To investigate the effective restoration method in penile partial defect.Meth-ods:To measure the thickness of suspensory ligaments on cadavers;To find the relationship between in-ferior pubic ramus and corpora cavernosa crus through corpora cavernosa angiography and ultrasonic scan-ning.The procedure of restoration was based on the use of dissection of the suspensory ligaments and partof crus,and the local fat flap had been transferred to fill the front space of symphysis ossium pubi.Vari-ous flaps were designed as coverage material.Penis residual stump was advanced to anterior portion of thenewly restoration penile body as“glans”;To take full layer skin of penis from post-operating patients toobserve neurofibril regeneration by light microscopy,electron microscopy and scanning electron microsco-py;To determine sensation recovery by physical examination;To check erectile function with NEVA Sys-tem.Results:The whole suspensory ligaments thickness was 7.66cm in average on 30 cadavers(60sides).The crus were attached to bilateral inferior pubic ramus respectively,and distal reached the mid-dle of inferior pubic ramus by corpora cavernosa angiography.In 14 health men by ultrasonic scan-ning,6.60cm in average from root of external penis to location of deep artery penis entered corpora cavernosa.Forty patients had been operated with the above methods.In the cases,the length of the penis variedfrom 0.5-4.0cm in the flaccid,2.0-6.0cm in erect state before operation to 5.0-8.5 cm in theflaccid,7.0-12.5cm in erect state after operation.Twenty-eight cases had been followed up for morethan one year,and 23 patients married with acceptable sexual life,eighteen men had successfully pro-duced their next generations.The regenerative neurofibril could be seen under light microscope,immuno-histochemistry marker,scanning and transmission electron microscope.The penis presented normal painand touch feeling in the post-operating cases.The results showed that there was similar erectile ability ofa normal male in the follow-up patients.Conclusion:With these basic and clinical researches,the resto-ration of penis tends to have a better appearance and function.It's a more optimal method compared withconventional procedures.The results have also provided valuable data for further study in related fields.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2004年第6期587-590,共4页
Journal of Peking University:Health Sciences
