应用人脱细胞异体真皮(HADM)治疗阴茎硬结症合并弯曲畸形的可行性分析

Feasibility analysis of the surgical management of Peyronie's disease and Penile curvature deformity using human acellular dermal mantrix

目的探讨采用人脱细胞异体真皮(human acellular dermal mantrix,HADM)在阴茎硬结症合并阴茎弯曲患者斑块剜除后修补白膜缺损的可行性。方法17例阴茎硬结症患者,侧方弯曲10例,向背侧弯曲6例,向腹侧弯曲1例,采用人脱细胞异体真皮作为补片材料行阴茎海绵体斑块切除阴茎白膜缺损修补手术,并在术前及术后3、6、12月接受IIEF-5问卷评分及RigiScan检测(NPTR模式)。结果17例患者术后阴茎均能恢复正常勃起形态、阴茎勃起疼痛症状消失、阴茎无明显弯曲畸形及硬结复发;部分患者阴茎干早期有感觉迟钝及感觉减退、勃起时牵拉疼痛等不适,半年后消失;术后5例对阴茎长度不满意,没有观察到相关合并症;3例患者术后性功能相比术前减退,予以PDE5i治疗后好转,14例术后性功能相比术前提高,均能完成满意的性生活;患者及性伴侣满意度均高。IIEF-5评分在术后3、6、12月分别为(20.20±1.26)、(22.60±1.08)、(22.80±1.14)分,均显著高于术前(18.20±1.88)分,P<0.05,术后6月及12月无统计学差异;RigiScan头端平均勃起硬度数据在术后3月、6月及12月分别为(60.25±2.08%)、(69.44±2.14%)、(70.22±1.48%)均高于术前(50.78±2.24%),P<0.05;术后6月及12月无统计学差异。结论利用HADM修复阴茎硬结症合并重度弯曲斑块切除后安全有效,但是需要开展随机双盲,其他移植物对照的研究。

Objective To evalate the feasibility for covering cavernosal defects after plaque incision using human acellular dermis material graft in the surgical management of Peyronie's disease.Methods Seventeen patients with Peyronie's disease who underwent plaque excision and corporoplasty with HADM graft were recruited in the study including 10 cases of lateral curvature,6 cases of dorsal curvature,1 case of ventral curvature,underwent plaque excision and corporoplasty with human acellular dermis material graft.We obtained and compared IIEF-5 scores and RigiScan of the patients before and at three、six and twelve months after operation were corporoplasty analyzed.Results After surgery,the penile of the patients restore normal erectile form,the symptoms of penile pain disappeared,there was no obvious bending deformity and recurrence of induration.some patients felt dullness and sensory decline in early penis dry and had erectile traction pain and discomfort,half a year later,the symphon disappeared.After operation,5 patients were not satisfied with their penile length and no related complications occurred.14 patients had satisfactory sexual life after operation,other 3 patients presented poorer sexual function but PDE5i treatment obviously improved their sexual function.The mean IIEF-5 score was significantly improved at 3 months(20.20±1.26)、6 months(22.60±1.08)and 12 months postoperatively(22.80±1.14)as compared with the baseline,(18.20±1.88)(P<0.05),The mean Avg Event Rigidity of RigiScan was significantly improved at 3 months(60.25±2.08%)、6 months(69.44±2.14%)and 12 months postoperatively(70.22±1.48%)as compared with the baseline,(50.78±2.24%)(P<0.05).Some patients with early penis dry feeling dullness and sensory decline,erectile traction pain discomfort,half a year later disappeared.5 cases were not satisfied with the length of the penis.No complications were observed.Conclusion All the data suggest that covering cavernosal defects after plaque incision using HADM graft in the surgical management of Peyronie's disease is safe and effective,but a randomized double-blind and other graft-controlled study need to be further carried out for confirming this conclusion.