阴茎海绵体延伸加带蒂皮瓣转移治疗不完全性阴茎缺损(附42例报告)

Reconstruction of penile partial defect with corpora cavernosa lengthening and pedicle skin flap transferring (report of 42 cases)

目的 探讨具有感觉与勃起功能的阴茎修复方法治疗阴茎不完全性缺损。 方法 ①手术方法 :离断全部浅、深悬韧带 ,分离部分海绵体脚 ,使阴茎更为延伸 ;用含血运的脂肪瓣转移填塞耻骨前间隙 ,保证术后远期阴茎的有效长度 ;选用合适的带蒂皮瓣转移覆盖海绵体 ,塑造外形更为美观的阴茎体部 ;阴茎残端整形塑造逼真的阴茎头和冠状沟样外观。②术后随访方法 :对术后患者取移植皮瓣全层皮肤 ,分别进行光镜、免疫组化、透射电镜和扫描电镜等检测 ,观察皮肤神经再生情况 ;通过对修复阴茎皮肤的触觉、痛觉及两点分辨觉 (复合感觉 )的检测 ,了解感觉功能恢复情况 ;采用夜间阴茎勃起测定系统检测阴茎修复后的勃起功能。 结果 ①修复阴茎 4 2例 ,术前残留阴茎常态下长度 0 .5～ 4 .0cm ,勃起时长度 1.5～ 5 .0cm ;术后常态下长度 5 .0～ 8.0cm ,勃起时长度 7.0～ 12 .5cm ;随访 1年以上者 2 8例 ,已婚 2 3例 ,性生活基本满意 ,已育 18例。②移植皮瓣术后 12个月光镜观察 ,真皮层内可见末梢神经束 ;免疫组化标记神经纤维束的细胞浆内可见神经纤维细丝蛋白阳性颗粒 ;透射电镜和扫描电镜均可见再生的神经纤维束及相关组织。修复阴茎已有触觉、痛觉及两点分辨觉。③勃起功能测定 :术后 12个月以上患者夜间 8～

Objective To investigate the reconstructive method with better sensory and erectile function for partial penile defect. Methods The procedure was as follows: dissecting the suspensory ligaments and separating part of crus,the local fat flap was transferred to fill the front space of symphysis ossium pubica.Various pedicle skin flaps were designed as covering materials.Penis residual stump was advanced to anterior portion of the newly reconstructed penile body as “glans”.The post-operative follow-up included taking full layer skin of penis from the patients to observe neurofibril regeneration by light microscope, electron microscope and scanning electron microscope;determining sensation recovery by physical examination;and checking erectile function with NEVA system. Results 42 patients underwent the above mentioned procedures.In these cases,the length of the penis varied from 0.5～4.0 cm in flaccid,1.5～5.0 cm in erect state before operation to 5.0～8.0 cm in flaccid,7.0～12.5 cm in erect state after operation.28 patients were followed up for more than 1 year.Of them 23 men got married with acceptable sexual activity;in them 18 had their children.The microscopic examination showed that the tenuous wavy peripheral nerves were well differentiated and no denaturation and necrosis were observed in the dermis,near subcutaneous adipose and around eccrine glands.The positive granules could be seen in the cytoplasm of regenerative neurofibrils by immunohistochemistry technique.The regenerative neurofibrils and related tissues could be seen under scanning and transmission electron microscope.The penis presented normal pain,touch feeling and 2-point identification ability in more than 12 months after surgery.Over 12 months after surgery,the patient had gained 4～9 events during 8～12 hours of sleep, and the durations were 4 to 37 min;the volume changes were from 114% to 505% over baseline. Conclusions With this method,the reconstructed penis tends to have better appearance and functions.For penile partial defect it is superior to the conventional operation.