白膜削除—折叠缝扎术治疗Peyronie’s病和先天性阴茎弯曲畸形

A New Surgical Treatment for Peyronie's Disease and Congenital Penile Curvature by Tunical Shaving and Plication

目的 探讨治疗Peyronie’s病和先天性阴茎弯曲新的手术方法。方法 手术取包皮环切口 ,分离暴露白膜 ,生理盐水灌注海绵体诱发勃起 ,明确弯曲部位、程度和方向 ,确定白膜削除的部位和范围 ,于弯曲的凸面分离背血管神经束或尿道海绵体 ,牵开并保护 ,用小园刀卵圆形削除双侧白膜浅层 ,丝线内翻折叠缝合创损的白膜 2～ 3针 ,其中 3例背深静脉漏者同时行背深静脉结扎术。结果 弯曲矫正率 10 0 %,术后无血肿、感染发生 ,勃起功能无影响 ,随访 1/ 2～ 4年 ,无弯曲复发 ,13例有满意性交 ,3例背深静脉结扎者 1例有自发性勃起 ,2例需依赖万艾可 (Viagra)性交。结论 白膜削除 折叠缝扎术可完全矫正阴茎弯曲畸形 ,且不损伤海绵体血窦 ,无出血和勃起功能影响 ,白膜粘连愈合牢固 ,无缝线断裂复发的可能。因而 ,白膜削除 折叠缝扎术是矫正阴茎弯曲畸形的简便、安全、有效的方法。

Objective To evaluate a new surgical method for Peyronie's disease and congenital penile curvature.Methods Of 16 patients with abnormal penile curvaturt(7 with Peyronie's disase and 9 with congenital deformity),5 was doral curvature and 11 was ventral. Their erectile curvature angle ranged from 30°～ 60° and erectile length wals 11～15 cm. 3 cases with Peyronie's disease complicated with erectile dysfunction due to deep dorsal venous leakage . Circumcision incision l cm proximal coronal sulcus was made and tunical albuginea was exposed by dissecting. Penis was infused with normal saline to achieve erection to define the point and degree of deformity and determine the area of shaving . The dorsal neurovascular bundle or corpus spongiosrm was dissected and protected to avoid its injury.Outer layer of tunical albuginea was shaving elliptically until thin layer was left behind with small knife. Then thin layer was plicated with two to three sutures of 3 cases with venous leakage the deep dorsal vein was ligated to recure their erectile function.Results Penile curvature was corrected completely in all patients.No hematoma and infecion or erectile dysfunction were occurred postoprativelly. By following-up 1/2～4 years,penile curvature is not recurrented. 13 patients are satisfied with intercourse. Of 3 cases with venous leakage,1 recure physical erection, 2 can do coitus successfully by using viagra .Conclusion Penile curvature is corrected by tunical shaving and plication,and it does not damage delicate spongy eretile tissue. Adhesion healing of shaved and plicated tunica avoid recurrence of penile formidity because of suture breakage .Then,this new surgical method is simple, safe and effective for abnormal penile curvature.