基于逆行设计方法的阴茎头成形术在阴茎再造中的临床应用

Clinical study of novel glanuloplasty based on retrograde design method in phalloplasty

目的:探讨应用三维逆行设计方法改进阴茎头成形术的临床应用价值和效果。方法:回顾性分析2019年4月至2022年3月中国医学科学院整形外科医院收治的应用新型阴茎头成形术进行阴茎再造的患者资料。术前通过三维逆行设计方法,体外构建正常人大小的阴茎模型,覆膜并临摹形成纸样,分为"头""颈""体""尾"4部分。术中按照临摹纸样切取"箭形"股前外侧皮瓣构建阴茎头和尿道,以双侧股薄肌和阔筋膜组装构建阴茎体,表面行薄中厚皮片移植。术后对新阴茎头外观及触觉、新阴茎体的静态长度和周径变化、患者满意度进行评估。结果:共纳入5例患者,年龄20~32岁,平均23.4岁;会阴型尿道下裂3例,先天性小阴茎1例,外伤性阴茎缺如1例。术后阴茎头均成活良好,尿道外口位于阴茎头顶端。供区均可完全缝合,无需植皮,供区均愈合良好。所有患者均于一期术后6~9个月进行了二期尿道吻接手术。术后随访6~12个月,新阴茎头无变形,且触觉有不同程度的恢复。所有患者均对新阴茎头的色泽、大小和外观表示满意。新阴茎均可在术后6个月左右自主收缩,完成勃起动作,并维持一定的硬度。新阴茎的长度和周径在术后3个月内均有一定程度的减少,但在6个月时基本稳定,阴茎体长度变化率为-10.34%~-25.00%,周径变化率为-5.88%~-13.89%。二期尿道吻合完成后,所有患者均可站立排尿,且尿线正常。结论:以皮瓣逆行设计理念切取的"箭形"股前外侧皮瓣可以构建更加逼真的阴茎头,并在临床实践中获得良好预后。

Objective To explore the clinical value and effect of the application of a three-dimensional retrograde design method to improve glanuloplasty.MethodsPatients treated with novel glanuloplasty from April 2019 to March 2022 in the Plastic Surgery Hospital,Chinese Academy of Medical Sciences were analyzed retrospectively.Before the operation,a normal penis model was constructed in vitro by a three-dimensional retrograde design method.Copy and rub the shape of the neopenis,which was divided into four parts:head,neck,body,and tail.During the operation,the"arrow"anterolateral thigh(ALT)flap was harvested to construct the neoglans and urethra,the bilateral gracilis muscles and fascia lata were assembled to construct the penile shaft,and free skin graft acted as the foreskin to cover the wound.The appearance and touch of the neoglans,the change in the length and circumference of the neopenis,and the patient’s satisfaction were evaluated.ResultsFive patients were enrolled,with an average of 23.4(20-32)years.Among them,3 cases were diagnosed as perineal hypospadias,1 case was congenital micropenis,and 1 case was traumatic penile absence.All the neoglans survived well after the operation,and the meatus of the urethra was located at the top of the neopenis.The donor sites could be sutured primarily without skin grafting.All patients underwent secondary urethral anastomosis 6-9 months after the first stage.Follow-up for 6-12 months after the operation showed that the neoglans had no deformation and the tactile sensation had recovered well.All patients were satisfied with the color,size,and appearance of the neoglans.The neopenis could contract spontaneously about 6 months after the operation,get erection and maintain a certain hardness.The length and circumference of the neopenis decreased to a certain extent within 3 months after the operation,but it was stable at 6 months.The change rate of length was-10.34%to-25.00%,and the change rate of circumference was-5.88%to-13.89%.All patients could urinate in the standing position,and the urine line was normal after the second stage of urethral anastomosis.ConclusionBased on the concept of retrograde flap design,the"arrow-shaped"ALT flap can construct vivid neoglans and obtain a good prognosis in clinical practice.This technique is easy to operate and can be used for preoperative three-dimensional simulation of body surface organs.