女变男易性者行阴道黏膜预制尿道阴茎再造的临床效果

Preconstruction of the pars pendulans urethrae for phalloplasty with vaginal mucosa in female to male transsexuals

目的 研究女变男易性者以废弃的阴道黏膜于腹部预制尿道行阴茎再造,并与传统的前臂皮瓣游离移植阴茎再造法（简称前臂皮瓣法）进行比较.方法 2007-2016年,以新的阴道黏膜预制法再造阴茎治疗22例女变男易性者,一期手术除常规行子宫、卵巢、乳腺以及阴道切除外,将切下的全厚阴道黏膜埋植于下腹部皮下预制尿道,6个月后掀起预制腹部皮瓣行阴茎再造,术后所有病例随访6个月以上,并与31例前臂皮瓣法比较手术时间、满意度和术后尿道并发症.结果 阴道黏膜预制法所有再造阴茎均完全成活,均可站立排尿,与前臂皮瓣法比较,可显著减少供区瘢痕,提高易性者满意度,缩短手术时间,减少术后尿道狭窄的发生（P＜0.05）.结论 在女变男易性者的治疗中,以阴道黏膜预制尿道行腹部皮瓣阴茎再造,方法可靠,与传统的前臂皮瓣法比较,能显著降低术后尿道狭窄的发生,显著减少供区瘢痕,操作简单.

Objective To investigate the feasibility of urethral prefabrication with vaginal mucosa in female-to-male transsexuals and to compare the urologic complications after penile reconstruction in female-to-male transsexuals between prefabrication group and forearm group.Methods Prefabrication of the neourethra with tubed vaginal mucosal graft was performed for 22 female-to-male transsexual patients from 2007 to 2016,while radial forearm flap,known as the traditional tube-within-tube method,was used to construct the neourethra for other 31 cases.Results All of the reconstructed penises survived completely and allowed the patients to urinate while standing in the prefabrication group.Phalloplasty by using the vaginal mucosal graft for urethroplasty significantly decreased the donor scar,the duration of the second operation and the incidence rates of urologic strictures,comparing with the forearm group （P〈0.05）.Conclusions It is reliable to use the prefabrication of the neourethra with tubed vaginal mucosal graft in phalloplasty female-to-male transsexual patients.