阴茎折断伤临床单中心25年诊疗体会及分析

Analysis on diagnosis and treatment of penile fractures in single clinical center in recent 25 years

目的总结临床单中心25年阴茎折断伤的流行病学特点、诊断与治疗经验，以提高对该病的诊治水平。方法采用回顾性病例系列研究分析1993年1月-2017年6月收治的23例阴茎折断伤患者临床资料，年龄21～66岁，平均37．78岁。已婚19例，未婚4例。其中14例发病于夏季，其余冬季5例、春季3例、秋季1例。大学及以上学历3例，大学以下学历20例；来自城市9例，农村14例。致伤原因：粗暴性交19例，暴力手淫2例，口交1例，不愿说明原因1例。23例均为单侧白膜破裂，其中5例合并尿道断裂，均未误诊漏诊。均急诊手术，受伤至手术时间：1993-2002年，平均32h；2003-2012年，平均10．5h，2013-2017年，平均3．8h。均采用阴茎远端环形脱套法修补阴茎白膜。观察术后阴茎勃起功能、排尿情况及并发症发生情况。结果患者均获随访6～62个月，平均26个月。所有患者术后1～3d恢复晨问勃起。拔除尿管后均能正常排尿。均于3个月内恢复正常性生活。1例阴茎皮肤愈合不良并阴茎象皮肿，1例轻度阴茎勃起疼痛。均未出现明显阴茎勃起功能障碍、排尿异常等严重并发症。结论阴茎折断伤具有发病率低、发病年龄及地域相对聚集、发病原因多样，以及患者文化程度偏低等流行病学特点。通过病史及体检多可确诊，急诊手术是阴茎折断伤的首选治疗方法，术后效果满意，并发症较少。

Objective To summarize the epidemiological features, diagnosis and treatment of the penile fractures in single clinical center in recent 25 years so as to improve the treatment level. Methods A retrospective case series study was conducted on 23 patients with penile fractures from January 1993 to June 2017. The average age of patients was 37.78 years （range, 21-66 years）. Nineteen patients were married and four were not. Fourteen patients had penile fractures in summer, five in winter, three in spring and one in autumn. Three patients had Bachelor degree or above, while 20 had less than university education. There were nine urban and 14 rural residents. Nineteen patients were caused by violent intercourse, two by violent masturbation, one by oral sex and one without willing explanation. All patients were unilateral rupture of albuginea penis, including five with urethral rupture. No misdiagnosis or missed diagnosis occurred. The time from injury to surgery was average 32 h （1993 -2002） , 10.5 h （2003-2012） , and 3.8 h （2013 -2017）, respectively. Emergency operations were performed using the degloved distal foreskin to repair the albuginea penis. The penile erectile function, urination and complications were recorded. Results All patients were followed up for 6-62 months （mean,26 months）. In all patients, morning erection was restored at days 1 to 3 after operation, and normal urination was attained after the removal of urethral catheter. Normal sexual life was restored within 3 months after the operation. Penis elephantiasis combined with poor postoperative skin healing was seen in one patient, and mild penile erection pain was reported by one patient. No obvious erectile dysfunction, abnormal urination or other severe complications were reported. Conclusions The epidemiological features of penile fractures include low incidence, relatively concentrated region and age of onset, diversity of causes, and patients with insufficient education. Penile fractures can be diagnosed based on medical history and body examination. Emergency surgery is the first choice for penile fracture, with satisfactory outcomes and few postoperative complications.