阴茎毁损性电烧伤的治疗时机与方法  

Opportune time and method of reconstruction of penile defects caused by devastating electrical burn

作　　者：刘毅[1] 肖斌[1] 刘萍[1] 姜疆[1] 宋玫[1] 陈黎明[1] 徐承新[1] 孙晓晨[1] 张鲜英[1] 张诚[1] 张绪生[1] 

机构地区：[1]兰州军区兰州总医院全军烧伤整形外科中心,730050

出　　处：《中华烧伤杂志》2014年第5期394-399,共6页Chinese Journal of Burns

摘　　要：目的 探讨治疗患者阴茎毁损性电烧伤的时机与适宜方法. 方法 1998年9月-2013年8月笔者单位收治13例阴茎毁损性电烧伤患者,通过换药清除坏死组织后,根据阴茎损伤程度,分别选择阴囊或腹部的局部皮瓣或瓦合皮瓣、前臂预制瓦合皮瓣、前臂游离皮瓣修复缺损或再造阴茎. 结果 采用阴囊或腹部局部皮瓣修复的2例患者,皮瓣成活,伤口愈合良好;阴囊瓦合皮瓣修复的2例患者术后6～9个月发生尿道炎,经药物治疗而愈.该4例患者排尿和阴茎勃起功能均正常.以腹部瓦合皮瓣或前臂预制瓦合皮瓣修复的5例患者,皮瓣全部成活,2例伤口愈合良好;3例伤口发生不同程度裂开,经二三次修整缝合,伤口愈合.该5例患者阴茎均有勃起功能,但排尿时尿线欠流畅,3例已婚者能正常进行性生活.以前臂游离皮瓣行阴茎再造的4例患者,皮瓣成活,伤口愈合良好,其中1例发生尿瘘,经Ⅱ期修复治愈.该4例患者排尿均正常,其中2例阴茎残存部分海绵体者有一定的勃起功能,但4例患者均不能正常进行性生活.术后随访6～13个月,常态下阴茎长5.9～9.3 cm、周径8.4 ～10.0 cm,伤口瘢痕均不明显,9例患者自述勃起时有牵拉感. 结论 阴茎毁损性电烧伤宜在清除坏死组织后进行皮瓣修复,其中阴茎海绵体和/或尿道海绵体小部分坏死,或伴尿道部分缺损者,采用阴囊或腹部局部皮瓣、阴囊瓦合皮瓣修复;尿道海绵体大部分或完全坏死伴尿道缺损者,采用腹部瓦合皮瓣或前臂预制瓦合皮瓣修复;阴茎与尿道海绵体大部分坏死伴尿道缺损或阴茎完全缺损者,采用前臂游离皮瓣行阴茎再造.Objective To explore the timing and suitable method of reconstructing penile defects caused by devastating electrical burn.Methods Thirteen patients with penile defects after devastating electrical burn,hospitalized from September 1998 to August 2013,were included in this study.After the necrotic tissues in the wounds were removed by dressing changes,a local or a hinge-like flap constructed from scrotum or abdominal wall,a prelaminated hinge-like flap from forearm,or a free forearm flap was selected,according to the injury degree of the penis,for the repair of the defect or reconstruction of penis respectively.Results The flaps survived and the wounds healed well in 2 patients repaired with local flaps from scrotum or abdominal wall.Urethritis occurred in 2 patients 6 to 9 months after the transplantation of hinge-like flaps from scrotum,and they were cured by appropriate drugs.Functions of urination and erection of penis were recovered in these 4 patients.All flaps survived in the 5 patients repaired with hinge-like flaps from abdominal wall or prelaminated flaps from forearm.The wounds in 2 patients healed; wound dehiscence occurred in the other 3 patients in different degrees,and they healed after suturing for 2 or 3 times.The function of erection of penis recovered in these 5 patients,but with discontinuity of urinary stream during urination.Among them,3 married patients enjoyed satisfactory sexual life.All free forearm flaps survived and the wounds healed well in 4 patients.Urinary fistula occurred in 1 patient,and it was repaired by a secondary operation.These 4 patients experienced normal urination function,but only 2 patients in whom corpus spongiosum partially remained retained the function of erection of penis to certain degree.All these 4 patients could not perform normal sexual intercourse.All patients were followed up for 6 to 13 months after surgery.Under ordinary state,the length of penis was 5.9-9.3 cm,and the circumference of penis was 8.4-10.0 cm.Wound scar was not obvious in all cases.Nine pati

关 键 词：烧伤 电 阴茎 修复外科手术 时机 

分 类 号：R647[医药卫生—外科学]