五种阴茎再造术的随访研究

Follow-up study of phalloplasty using five methods

目的总结评价5种不同阴茎再造术的总体疗效，寻找影响手术效果的相关因素。方法对1997年6月至2011年11月接受阴茎再造术治疗的67例患者，对比既往病历，测量术后阴茎的形态变化，采用S0-S4七级标准测量感觉恢复情况，并对术后支撑物影响及并发症进行统计分析。结果本组共67例患者，术后随访3～168个月，平均80．3个月，髂腹皮瓣法术后形态变化较小，前臂皮瓣法感觉恢复最好，阴茎假体置入对性生活满意度有积极影响，脐旁皮瓣法术后尿瘘发生率较高，阴股沟皮瓣法更容易发生尿道狭窄。结论根据患者的具体情况灵活运用手术方法，术前及术后BMI的控制和及时随诊有利于减少并发症的发生。

Objective To evaluate generally the clinical and functional outcome of five different methods of phalloplasty and assesses some related influential factors. Methods Compared with postoperative penile shape changes measured from anamnesis, sensory recovery in 67 patients who accepted phalloplasty from June 1997 to November 2011 were measured by S0-S4 seven-grade standard and postoperative penile implant and complications were analyzed statistically. Results Follow-up was performed on 67 cases for 3 to 168 months （ average 80.3 months）. Comparatively, patients using superficial inferior epigastric artery flap had the least shape changes postoperatively, those who undergone the radial forearm free flap achieved the best feeling, the method of penile prosthesis implantation could get a positive impact on sexual life satisfaction, the way of deep inferior epigastric artery perforator flap caused higher incidence of urinary fistula and the approach of pudendalthigh flap could make urethral stricture easy. Conclusion Flexible use of operation methods in accordance with the specific circumstances of the patients, preoperative and postoperative BMI control and timely follow-up helps to reduce the incidence of complications.