摘要
目的探讨短波热疗致阴茎坏死后缺损的修复方法及疗效。方法2004年1月至2012年6月收治的短波热疗致阴茎坏死患者18例。年龄18～55岁，平均34岁。已婚15例。18例清创后阴茎次全缺损10例，全缺损6例，阴茎海绵体合并尿道海绵体部分坏死2例。全麻下，10例阴茎次全缺损者行阴茎延长术；6例阴茎全缺损者中，4例行腹壁下动脉穿支皮瓣阴茎再造术，2例行前臂游离皮瓣阴茎再造术；2例阴茎海绵体合并尿道海绵体部分坏死者采用阴囊皮瓣及两侧筋膜蒂皮瓣再造尿道，二期植入肋软骨修复阴茎海绵体。结果本组18例手术均顺利完成。随访0．5～10．0年，平均2．3年。16例阴茎全缺损或次全缺损者，阴茎体外部分常态下长度为6．3～9．2cm，勃起时长度8．7—11．5cm，均无感觉及勃起功能障碍发生，阴茎的外形及感觉功能恢复良好，供区瘢痕不明显。术后15d发生皮瓣远端坏死和切口裂开各1例，经清创及换药后痊愈。术后1年均未见皮瓣萎缩，1例术后阴茎臃肿影响美观及性生活，经局部吸脂后缓解。2例阴茎海绵体合并尿道海绵体部分坏死者行尿道再造术后1个月排尿正常，二期植入肋软骨后，阴茎感觉及勃起功能未见异常。结论对于短波热疗导致的阴茎坏死，应根据阴茎缺损的类型合理选用皮瓣进行个体化修复。
Objective To explore the strategy of repairing penile defect after necrosis caused by shortwave diathermy. Methods Between January 2004 and June 2012, 18 cases with penile defect after necrosis caused by shortwave diathermy were admitted in our hospital. The age of those patients ranged from 18 to 55 years old （mean 34 years old）. Among them, 15 cases have been married. All patients have the history of penile shortwave diathermy therapy after surgery. After debridement, penile complete defect was found in 6 cases, incomplete defect was found in 10 cases and corpus eavernosum and corpus spongiosum partly defect was found in 2 cases. Under general anesthesia, we applied penis extent in 10 cases with incomplete defect, forearm free flap in 2 cases with penile complete defect, abdominal artery perforators flap in other 4 cases with penile complete defect. In 2 cases with corpus eavernosum and corpus spongiosum partly defect, the serotal septal skin flap and fascia pediele flap was used for 1-stage urethral reconstruction and eosticartilage was implanted for 2-stage eavernosum reconstruction. Results 18 patients were followed up for 0.5-10.0 years （mean 2.3 years）. 16 cases with penile complete defect or incomplete defect had normal length after operation, ranged from 6.3 to 9.2cm. During erectile phase, the length of their penis ranged from 8.7 to 11.5 em. No feeling abnormality or erectile dysfunction was complained. All patients exhibited the excellent morphology and felling of penis with minor scar in donor site. Early （ half a month） complications included distant flap necrosis in 1 case and disruption of the wound in 1 case, which were cured after debridement and conventional treatment. After one year, we did not see the flap atrophy. One case had tumid which influenced penile beautiful and sexual intercourse. It was improved by local liposuction. One month after sur- gery, two patients with corpora cavernosa and corpus spongiosum partial defect had normal voiding. No feel- ing and erectile dysfunction were complained during the following-up. Conclusions According to the characteristics of the penile defect due to the shortwave diathermy, selecting the optimal skin flap and individual repair strategy are the keys to successful treatment.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2014年第11期860-863,共4页
Chinese Journal of Urology
关键词
短波热疗
阴茎
缺损
修复
Shortwave diathermy
Penis
Defect
Repair
