阴茎烧伤后会阴部瘢痕挛缩畸形的治疗及患者性功能康复分析

Perineal scar contracture treatment andthe sexual function rehabilitation of patients after penis burn

目的:探究阴茎烧伤后会阴部瘢痕挛缩畸形的治疗方案,分析手术治疗对烧伤患者性功能的影响。方法:选择2008年4月至2012年4月期间我科收治的40例深度阴茎烧伤后会阴部瘢痕挛缩畸形患者,对患者行游离皮片移植、局部皮瓣转移、带蒂轴型皮瓣等手术治疗,观察手术治疗后的近期疗效与远期疗效,并分析手术治疗对患者性功能的影响。结果:40例烧伤患者经过游离皮片移植、局部皮瓣转移、带蒂轴型皮瓣等手术治疗,23例皮片完全存活,14例患者皮片变为暗紫色,经过药物治疗均痊愈,3例患者出现局部坏死,经过针对性的治疗,糜烂明显得到控制与改善。经过2年的随访,36例患者生殖器复位,4例患者出现疤痕挛缩,36例患者的下肢外展、下蹲以及行走等基本生理功能明显得到改善与提高;经过手术治疗的40例患者的IIEF-5平均评分为(21.40±6.50)分,显著术后的IIEF-5平均评分,且勃起正常的例数显著高于术前例数,勃起障碍例数显著低于术前例数,均具有显著性差异(P<0.05)。结论:根据患者疤痕部位、疤痕面积、年龄、体质等状况选择游离皮片移植、局部皮瓣转移、带蒂轴型皮瓣以及皮肤扩张等手术方法。经过手术治疗,患者的IIEF-5评分显著提高,勃起功能障碍明显得到改善。

Objectives：To explore the penis perineal burn scar contracture treatment programs,analyze the impact of surgical treatment on patients＇ sexual function.Methods：40 penis perineal scar contracture burn patients admitted to our hospital from April 2008 to April 2012 were selected and treated with free skin graft,local flaps,pedicled axial flaps and other surgical treatment.The short-term and long-term efficacy of surgical treatment was recorded,and the effect of surgery on the sexual function of patients was analyzed.Results：After treatment,the skin grafts of 23 patients survived completely,and turned to dark purple in 14 patients which recovered after drug treatment,and turned to partial necrosis in 3 patients,whose erosion was under control after targeted therapy.After2 years of follow-up,genital of 36 patients reset,4 patients had scar contractures,and the lower limb abduction,squatting and walking and other basic physiological function of 36 patients was significantly improved and improved.The IIEF-5 average score of the 40 patients after treatment was 21.40 ± 6.50,and the number of patients having normal erection was much larger and the number of those having erectile dysfunction was significantly lower,all with significant differences （P〈0.05）.Conclusion：Free skin graft,local flaps,pedicled axial flaps and skin expansion and other surgical methods was chosen according to patients＇ location of scar,scar area,age and physical condition.After surgery,the IIEF-5 score and erectile dysfunction of patients was significantly improved.