男性外生殖器修复与重建

Surgical repair and reconstruction of male external genitals

各种原因引起的外生殖畸形、缺损,以及由此导致相应的排尿功能、性功能、生育功能的障碍和外观异常,是男科诊治中的难点之一,目前尚无相应的诊疗常规和指南。对此,有效的治疗方法是进行修复和重建手术,其关键点是根据局部病变和功能受损情况设计术式,常常需要利用转移皮瓣、带血管皮瓣等各种皮瓣或植皮等方法进行修复。文中介绍了临床上常见的男性阴茎、阴囊畸形和缺损疾病,注重外形的修复和功能的重建,采用泌尿和男科手术技巧,结合显微外科技术、皮瓣和皮肤移植技术等方法进行修复,获得较为满意的外观和较好的功能。术前应充分评估病变程度,合理设计术式,并与患者认真沟通,帮助患者理解和认识手术预期效果及其预后,消除患者心理上对手术的过高期望。有些修复手术难度大、并发症多,需要在临床工作中进一步研究和改进。

One of the challenges in andrology nowadays is the diagnosis and treatment of external genital abnormalities and defects along with the consequent voiding,sexual,and reproductive dysfunctions,for which no guidelines are yet available. Hitherto,surgical repair and reconstruction are efficient for these diseases. The key to these operations is to individualize surgical strategies according to the specific local lesion and dysfunction,usually involving flap and graft techniques. This article presents our experience in the surgical treatment of penile and scrotal abnormalities and defects with urological and andrological techniques and microsurgical strategies,focusing on the external repair and functional reconstruction. Satisfactory treatment outcomes pivot on a precise evaluation of the disease,a rational design of surgical procedures,and an earnest communication with the patient. Some cases are rather complicated and challenging,usually with complications,and therefore deserve further researches for more effective treatment strategies in clinical practice.