阴茎背神经阻断术后神经离断的修复及疗效评价

Efficacy evaluation of sural nerve bridging transplantation for restoration of penis disturbance of sensation after selective dorsal nerve neurotomy

目的探讨应用腓肠神经桥接移植修复阴茎背神经阻断术后神经离断的临床疗效。方法 2014年5月—2016年5月,采用腓肠神经桥接移植修复阴茎背神经阻断术后神经离断患者23例。患者年龄19~38岁,平均27岁。病程1~28个月,平均14个月。术前患者主要表现为阴茎性快感、冷热感觉及触觉敏感度减退等感觉障碍。21例患者自诉勃起障碍。所有患者激素水平正常,无其他器质性疾病,无手术禁忌证。根据症状自评量表-SCL90评估,患者存在抑郁19例、焦虑16例,其中焦虑及抑郁共存15例;其余心理异常情况(社交障碍等)3例。术中发现缺损神经总长度为1.0~1.5 cm。根据英国医学研究院神经外科学会感觉功能评定标准,评定静态两点辨别觉、感觉分级情况,记录性快感障碍、冷热感觉及触觉敏感度等主观感觉情况;对阴茎背神经阻断术后勃起功能采用国际勃起功能指数-5(IIEF-5)问卷调查表进行评估;应用症状自评量表-SCL90进行心理状态评估。结果术后患者切口均Ⅰ期愈合。23例患者均获随访,随访时间6~12个月,平均8个月。术后6个月性快感较术前明显改善11例,部分改善5例;冷热感觉及触觉敏感度改善21例;各方面均无明显改善1例。术后3、6个月患者静态两点辨别觉、感觉分级情况以及IIEF-5问卷调查表评定结果均较术前显著改善,比较差异有统计学意义(P<0.05)。术后6个月根据症状自评量表-SCL90评估,与术前相比,抑郁改善14例(73.68%),焦虑改善12例(75.00%),焦虑和抑郁共存改善12例(80.00%)。结论腓肠神经桥接移植修复阴茎背神经阻断术后神经离断,可获得较好疗效。

Objective To evaluate the clinical effect ofsural nerve bridging transplantation for the restoration of penis disturbance of sensation after selective dorsal nerve neurotomy. Methods Between May 2014 and May 2016, 23 patients underwent sural nerve bridging transplantation for the restoration of penis disturbance of sensation after selective dorsal nerve neurotomy. The age ranged from 19 to 38 years （mean, 27 years）. The course of disease was 1- 28 months （mean, 14 months）. The defect length was 1.0-1.5 cm. Preoperative main neurological sign was sensory disturbance. The chief complaint of 21 patients was a erectile dysfunction; all had normal hormone levels, and there was no other organic diseases or surgical contraindication. According to the self-assessment lists of symptom-SCLg0 evaluation, 19 cases had depression, 16 cases had anxiety, and 15 cases had both anxiety and depression; 3 cases had psychological abnormalities （social barriers, etc.）. According to the functional neurological evaluation standard of British Medical Research Institute, the static two-point discrimination and sensation recovery standard rating were evaluated before and after operation; sexual pleasure obstacle sensitivity, temperature sense, and other subjective improvement were recorded. The International Index of Erectile Function 5 （IIEF-5） was used to evaluate questionnaire of the patient with erectile dysfunction before and after operation. The psychological state was accessed with the self-assessment lists of symptom-SCL90 evaluation after operation, Results All incisions healed by first intention, The mean follow-up time was 8 months （range, 6-12 months）. Sexual pleasure obstacle was obviously improved in 11 cases, partially improved in 5 cases; the improvements in temperature and tactile sensitivity were achieved in 21 cases; no obvious improvement was observed in 1 case. The sensation recovery standard rating, static two-point discrimination and grade of IIEF-5 were significantly improved at 3 and 6 months after operation when compared with preoperative ones （P〈0.05）. At 6 months after operation, symptom was improved in 14 of 19 patients with depression （73.68%）, in 12 of 16 patients with anxiety （75.00%）, and in 12 of 15 patients with anxiety and depression（80.00%）. Conclusion Sural nerve bridging transplantation is an effective method for the restoration of penis disturbance of sensation after selective dorsal nerve neurotomy.