阴茎完全离断再植二例报告并文献复习

Penile replantation： two case reports and review of the literature

目的探讨阴茎完全离断再植的方法。方法回顾性分析2例阴茎完全离断再植患者资料并复习文献。例1，34岁。被人以利刃切断阴茎3．5h后入院。查体：阴茎断端距根部2．5cm。端端吻合阴茎海绵体、尿道海绵体和尿道，显微外科技术吻合阴茎背动脉、背深静脉、背神经。例2，25岁。自行用菜刀将阴茎砍伤后15h入院。查体：距阴茎根部3em处阴茎完全离断，距阴茎根部2em处阴茎2／3部分离断。因阴茎被断为两处，不易分离吻合，仅吻合阴茎海绵体、尿道海绵体和尿道。结果例1术后阴茎充血、红润、恢复血供；术后阴茎皮肤坏死，出现尿道海绵体吻合口瘘。经清创减压，换药，修补尿瘘，阴茎埋入阴囊皮瓣；2个月后再次手术，将埋入的阴茎阴囊断蒂处理。伤口愈合良好，排尿正常。随访2年，阴茎外观良好，能自主勃起，无感觉异常。例2术后阴茎皮肤坏死严重，彩色多普勒超声检查阴茎未见血流，清创未见鲜活组织，伴有全身感染症状，切除移植物。结论阴茎离断伤早期及时治疗十分重要，静脉回流是阴茎离断再植成功的关键。阴茎背静脉、阴茎动脉和背神经显微外科手术吻合是阴茎再植的“标准”方法，阴囊双蒂皮瓣是阴茎再植术后并发症良好的修补材料。

Objective To present our experience of dealing with complete penile amputation. Methods Two cases of penile complete amputation were reported. The first case was a 34-year-old man, suffered amputation of the penis approximately 2.5 cm distal from the pubic area with a sharp knife. 3.5 hours later, the patient was transferred to our hospital. The urethra mucosa and corpus spongiosum were an- astomosed. The cavernous body of the penis was reattached by suturing the tunica albuginea of each corpus cavernosum to the corresponding proximal segment. One dorsal artery, two dorsal veins, and dorsal nerve were anastomosed under a 10 x microscope with interrupted 9-0 nylon nonabsorbable sutures. The second case was a 25-year-old man, presented to the emergency room 15 hours after distal penile amputation, which had 2 wounds as a result of self-mutilation caused by psychiatric problems. The urethra mueosa and corpus spongiosum were anastomosed. The cavernous body of the penis was reattached by suturing the tunica albu- ginea of each corpus cavernosum to the corresponding proximal segment using 4-0 polyglactic acid sutures. Results In the first case, the tourniquet was released after replantation, and the distal penis appeared to revascularize, as noted by the gradual increase in redness and size. An arterial pulse was detected, and the superficial penile veins displayed normal turgor, and no bleeding was found. On postoperative day 3, the pe- nile skin started to necrotize. On day 12, the necrotic skin was superficially debrided, and a fistula was ob- served in the corresponding urethral segment. Two weeks later, the fistula was sutured with 4-0 interrupted synthetic absorbable suture, and a transposition flap to embed the whole injured penis shaft was created from the proximal scrotal skin. The glans was exposed. Two months after the second operation, the embedded pc-nis was released from the scrotum. After follow-up of two years, the patient had glans re-epithelialization with normal voiding, sensation, and erections. In the second case, the glans was still pink, but the penile skin started to necrotize on postoperative day 3. On day 14, serious infections were noted, the necrotic skin was superficially debrided, and the amputated penis was relieved. Conclusions Prompt diagnosis and early treatment are essential to avoid the potential complications of isehemic necrosis and autoamputation. Venous outflow is a critical factor for success of replantation. Microsurgical reanastomosing of the dorsal pe- nile vein, penile arteries, and dorsal nerves can be identified as the %tandard~ method for penile replanta- tion. The bipedicled scrotal flap can provide adequate skin cover for penis defects.