16点法阴茎白膜折叠术治疗86例阴茎弯曲的长期疗效观察  

Long-term results of the surgical treatment of penile curvature with 16-dot plication ： a retrospective analysis of 86 patients

作　　者：王忠[1] 李文吉[1] 姚海军[1] 达骏[1] 蔡志康[1] 蒋跃庆[1] 徐明曦[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院泌尿男科,200011

出　　处：《中华泌尿外科杂志》2014年第12期931-935,共5页Chinese Journal of Urology

摘　　要：目的 评估16点法阴茎白膜折叠术治疗阴茎弯曲的长期手术效果、患者满意度及对性功能的影响. 方法 2004年8月至2010年12月,我们利用16点法阴茎白膜折叠术治疗92例阴茎弯曲患者,其中86例获长期随访.86例患者年龄20～66岁,平均32岁.53例为先天性阴茎弯曲,33例为阴茎海绵体硬结症（Peyronie disease,PD）引起的继发性阴茎弯曲.其中下弯45例,侧弯23例（向左侧弯曲13例,向右侧弯曲10例）,上弯18例.手术适应证包括阴茎弯曲影响外观、性交困难、不能性交或性交时女方感到不适者,阴茎弯曲角度30°～ 90°,阴茎勃起时长度超过10 cm.排除重度阴茎弯曲（弯曲角度＞90°）,或伴有严重的沙漏样畸形、巨大硬结斑块的PD患者.术前评价包括勃起功能国际问卷-5（international index of erectile function 5,IIEF-5）和勃起时疼痛感.建议患者术后第3周开始每日服用小剂量5型磷酸二酯酶（phosphodiesterase type 5,PDE-5）抑制剂连续2～3个月.术后随访内容包括手术并发症、阴茎弯曲复发、患者满意度和性功能状态. 结果 86例术后随访35～ 107个月,平均79个月.86例中82例患者（95.3％）和77例配偶（89.5％）表示总体上满意.79例（91.8％）阴茎勃起完全伸直,7例勃起时轻微弯曲但不影响性生活.35例（40.7％）术后阴茎勃起长度缩短,平均缩短1.3 cm,但患者均对术后阴茎长度表示满意.术后无患者出现手术相关的阴茎勃起功能障碍,IIEF-5评分显示术后性功能显着改善,小剂量服用PDE-5抑制剂2～3个月的患者性功能改善更明显.术后未发生出血、尿道损伤、感染等手术相关并发症. 结论 16点法阴茎白膜折叠术是治疗向任何方向弯曲的轻、中度阴茎弯曲有效且安全的手术方法,长期随访结果显示术后患者外观和性功能均可达到满意的效果.Objective To assess the long-term surgical outcomes,patient＇s satisfaction and functional results of correction for patients with penile curvature by 16-dot minimal tension plication.Methods Between August 2004 and December 2010,92 patients with penile curvature underwent surgical correction of penile curvature by 16-dot minimal tension plication.Of them,86 patients （53 patients with congenital penile curvature and 33 patients with Peyronie＇s disease （PD）） were reached for long-term follow-up.Indications for operation included patients with 30 to 90 degrees of penile curvature,penile length greater than 10 cm and patients who had one or more symptoms,such as difficulty or inability to vaginal penetration and partner discomfort during sexual intercourse.Patients were excluded from study if they had severe penile curvature （greater than 90 degrees）,hourglass deformities or large plaques.Preoperative evaluation included international index of erectile function 5 （IIEF-5） questionnaire score,pain on erection and physical examination.Patients were recommended daily low dose phosphodiesterase type 5 （PDE-5） inhibitors 2 weeks after surgery and maintained for 2 to 3 months.At follow-up,recurrence rate,complications,erectile function,patients and partner＇s satisfaction with the surgery were assessed.Results The mean time of follow-up was 79 months （range,35-107 months）.Of 86 patients who had been reached for long-term follow up,82 patients （95.3％） and 77 partners （89.5％） reported overall satisfaction after the surgery.Complete penile straightening was achieved in 79 patients （91.8％）.Slight residual curvatures were observed in 7 patients,but did not affect their sexual intercourse.Postoperative penile length shortening （median penile length loss 1.3 cm） was noted in 35 patients （40.7％）,which did not affect their sexual intercourse.In addition,no de novo erectile dysfunction was observed,and sexual function was significantly improved evidenced by the IIEF-5 scores,e

关 键 词：阴茎弯曲 16点法阴茎白膜折叠术 满意度 

分 类 号：R699.8[医药卫生—泌尿科学]