阴茎延长同期行脱细胞异体真皮基质补片双平面植入阴茎增粗术

Dual plane penile augmentation with human acellular dermal matrix through penile lengthening incision

目的探讨阴茎延长同期行脱细胞异体真皮基质（acellular dermal matrix，ADM）补片双平面植入阴茎增粗术的方法与效果。方法采用阴茎根部倒V形切口。离断阴茎浅悬韧带后，沿阴茎纵轴切开Dartos筋膜，在其深面向远端分离。距冠状沟1．5～2．0cm处环形切开Buck筋膜，将补片前部植于Buck筋膜与白膜间，后部植于Dartos筋膜与Buck筋膜间。缝合Dartos筋膜切口，V—Y成形术闭合阴茎根部切口。结果35例术后无1例发生阴茎皮肤坏死、补片外露并发症。25例获随访6～24个月，对阴茎外形均感满意；无1例出现补片移位或皱褶、阴茎头感觉异常；其中21例已婚者均感性生活满意。结论经阴摹根部切口行脱细胞异体真皮基质补片双平面植入阴茎增粗术，通过调整补片植入层次，在确保补片足够的组织覆盖及刚茎皮肤血供情况下，在I期内行延长并增粗阴：拳术，具有并发症少、疗效满意的优点。

Objective To illustrate the details and effects of a new technique of penile augmentation-a dual plane approach to enhance the penile girth with human acellular dermal matrix （ADM） through the incision on the dorsal penile root. Methods Firstly, a reversed V incision was made at the dorsal root of the penis and the superficial suspensory ligament of the penis was released. A Dartos fascia incision was then made and the plan belween Dartos fascia and Buck＇s fascia was dorsally dissected toward the coronary suIcus. A Buck＇s fascia incision was made 1.5-2 cm from the coronary sulcus and the fascia was undermined distally. One or two sheets of ADM was dorsally placed by a dual plane method which combined partial sub-Buck＇s fascia plane and partial sub-Dartos fascia plane to enhance the penile circumference. Finally, the Dartos fascia incision was closed and followed by the closure of the wound with V Y advancement. Results A total of 35 patients underwent dual plane penile augmentation No dorsal penile skin necrosis and exposure of ADM sheet happened in our group postoperatively. 25 patients were followed from 6 to 24 months after operation. All patients were satisfied with their penile appearance and 21 married palients reported satisfied sexual activity. The increase of penile circumference was （2.65±0.41） cm at flaccid state and （1. 85±0. 35） cm at erectile state 6 months posloperatively. No pleat or absorb of the ADM sheet, losses of sensitivity of the penis occurred during the follow-up period. Conclusions By adjusting the plane of ADM placement, the dual plane penile augmentation ensures adequate soft-tissue coverage and sufficient blood supply of penile skin and offers increased benefits and fewer tradeoffs compared with a single plane. This technique could be an effective way to lengthen and enlarge the penis in one stage without major complication.