连续Z形皮瓣在阴茎延长术中的应用  

Successive "Z" Incision and Skin Flaps:A Better Procedure for Penile Lengthening

作　　者：潘连军[1] 祝黎洁[2] 王忠[3] 蔡志康[3] 达骏[3] 董国勤[3] 黄宇烽[1] 

机构地区：[1]南京大学医学院临床学院/南京军区南京总医院男科,江苏南京210002 [2]无锡市第三人民医院泌尿外科,江苏无锡214041 [3]上海交通大学医学院附属第九人民医院泌尿外科,上海200011

出　　处：《中华男科学杂志》2008年第4期317-320,共4页National Journal of Andrology

基　　金：国家自然科学基金(30471725,30672110);上海浦江人才计划(05PJ14055);上海市科委基础重点课题(05JC14035)

摘　　要：目的:提供一种阴茎延长术中创面修复方法,即连续Z形皮瓣。方法:5例患者年龄为16～34(22.4±7.2)岁,有3例有既往手术史,分别为尿道下裂行尿道成形术、"包茎"行包皮环切术、隐匿型阴茎行阴茎松解术。采用连续Z形皮瓣行阴茎延长术,解剖并切断阴茎浅悬韧带和部分深悬韧带,皮瓣依次交叉对位,无张力下缝合。根据创面渗出液多少决定是否放置引流。插尿管1～2d,阴茎适当加压包扎,术后8～10d拆线。结果:该5例患者术前阴茎勃起长度为4.0～5.8(4.8±0.8)cm,术后为7.8～9.2(8.4±0.6)cm,有2个中学生术后性格变得开朗,自信心明显增强。切口均一期愈合,术后电话随访12～48(22.8±14.9)个月,无阴茎回缩,患者及家属基本满意。结论:对于伴有外生殖器畸形、既往手术后瘢痕、包皮环切手术后的患者,连续Z形切口与传统的倒V形、M形、Z形切口相比,能获得更长的延长距离,解决了皮瓣过紧甚至无法覆盖创面的难题,减少了术后并发症的发生。Abstract： Objective： To recommend the successive ＂Z＂ incision and skin flaps as a method for repairing the wound in penile lengthening procedures. Methods： We performed penile lengthening surgery by successive ＂Z＂ incision for 5 patients complaining of short penis, who ranged in age from 16 to 34 years （22.4±7.2） , and 3 of whom had a history of urethroplasty, circumcision and penile reconstruction, respectively. The superficial suspensory ligament and part of the deep suspensory ligament of the penis were exposed and severed to release the penis, and the ＂Z＂ skin flaps sutured in a tnesiordess state. Drainage was necessitated by exudation and the catheter removed in 24-48 hours. The penis was wrapped up by an elastic bandage, and the stitches taken out 8-10 days after the operation. Results： We achieved a mean erectile length of 8.4 cm （ range 7.8-9.2 cm） after the operation, as compared with 4.8 cm （ range 4.0-5.8 cm）before the surgery. Two students of the patients obviously became active and confident. No penile contraction wasnoted during the 12- 48 months follow-up, and both the patients and their family members were satisfied with the outcomes. Conclusion： Compared with the V-, M- and Z-incision, the successive ＂Z＂ incision and skin flaps can yield longer penile length, solve the problem of insufficient skin flap to cover the wound and reduce such complications as skin necrosis and infection. It is well worth recommending for patients complaining of short penis because of penile abnormity, post-operation scar on the penis or circumcision.

关 键 词：阴茎 阴茎延长术 Z形皮瓣 Z形切口 

分 类 号：R699[医药卫生—泌尿科学]