白膜整形术治疗阴茎弯曲的术式选择和效果分析

Correction of penile curvature by various tunica albuginea plasty

目的 探讨不同类型阴茎弯曲的白膜整形术术式选择和疗效.方法 2005年7月至2008年7月,共采用白膜整形术治疗不同类型阴茎弯曲患者8例,平均（34±9）岁,术前弯曲度为（58±10）°,国际勃起功能指数（IIEF-5）评分为15±5.其中运用白膜16点折叠术治疗阴茎下弯3例、阴茎侧弯1例;白膜V-Y改形术治疗阴茎侧弯合并白膜束窄环2例;自体大隐静脉游离移植白膜修补术治疗阴茎硬结症合并阴茎弯曲1例、白膜损伤后瘢痕收缩所致阴茎弯曲1例.手术前后采用IIEF-5评分系统对性功能满意度进行评估.结果 分别于术后3、6、9个月对患者进行随访,患者对手术效果均表示满意;阴茎静息态及勃起后外形良好,弯曲矫正至（11±4）°.IIEF-5评分为21±3,较术前显著提高（P＜0.05）.无术后血肿、感染、阴茎感觉异常等并发症发生.结论 对于不同类型的阴茎弯曲,针对性选择不同的白膜整形术进行矫治,可获得良好的治疗效果.

Objective To explore various tunica albuginea plasty for penile curvature and their efficacies. Methods From July 2005 to July 2008, there were a total of 8 patients with a mean age of 34 ±9 years old （range： 23 -47 ） undergoing corrective surgery for various types of penile curvature. Among them, 4 patients （3 with ventral curvature, 1 with lateral curvature） were treated by 16-dot plication technique, 2 patients of lateral curvature with tightening ring in tunica albuginea corrected by V-Y plasty and 2 patients （one caused by Peyronie＇s disease while the other by tunica scar contracture） repaired by venous graft patch. The pre-and post-operative levels of sexual satisfaction were evaluated by the International Index of Erectile Function （ IIEF-5 ） scoring system. Results All cases were followed up at 3, 6 ＆ 9 months postoperatively. Their mean curvature at maximal erection was （ 58.2 ± 9. 7 ） °. And a postoperative office assessment revealed a functional straight in all patients [mean degree （ 11 ± 4 ）°]. One patient （ 12. 5% ）reported penile shortening without dissatisfaetion about it. No patients complained of anesthesia or other sensory abnormality on their penile skin. An improvement of IIEF-5 scores was noted （21 ± 3 vs 15 ± 5,P ＜0. 05） and all patients were satisfied with their outcomes. No complications, such as hematoma,infection or erectile dysfunction, occurred. Conclusion To achieve a better penile morphology and functional outcomes with fewer complications, various orthoplasty should be adopted according to the cause,degree and direction of penile curvature.