包皮环切术后微波治疗致阴茎坏死9例报告  

Penile necrosis resulting from post-circumcision microwave diathermy:A report of 9 cases

作　　者：方丹波[1] 沈月洪[1] 朱选文[1] 方家杰[1] 毛褀琦[1] 汪超军[1] 谭付清[1] 何庆伟[1] 沈柏华[1] 谢立平[1] 

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,浙江杭州310004

出　　处：《中华男科学杂志》2015年第5期428-431,共4页National Journal of Andrology

摘　　要：目的：探讨包皮环切术后微波治疗致阴茎坏死发生机制及处理原则。方法：回顾2006年5月至2011年11月9例包皮环切术后微波治疗致阴茎坏死临床资料。患者为男性,年龄20～39岁（中位年龄26岁）,均在其他医院以包皮过长或包茎接受环切术,手术结束时未有阴茎缺血表现。术后1 h至3 d开始实施应用非接触式微波治疗。术后1～10 d出现阴茎坏死,伴感染4例。经换药等保守治疗无效,术后3～30 d来我院。9例中5例为干性坏疽,4例为湿性坏疽。6例为阴茎部分坏死,行阴茎部分切除术,其中1例于术后3个月接受阴茎延长术;其他5例未接受再手术。3例为全阴茎坏死,其中1例伴阴囊皮肤坏死;均在阴茎全切后3个月行阴茎再造术,其中2例行腹壁下深动脉穿支皮瓣（DIEP法）及自体第12肋阴茎支撑物植入;1例行髂腹股沟岛状皮瓣、阴囊皮管尿道成形术。结果：本组患者术后随访2～8年,均可站立排尿,排尿畅。1例于阴茎部分切除术后阴茎残留部3 cm,术后由3个月接受阴茎延长,阴茎长度延长至7 cm;5例未接受阴茎延长术,阴茎残端3～5 cm,其中4例有勃起功能,2例可进行性生活。3例行阴茎全切阴茎再造术,阴茎定型长度为（11.7±1.3）cm,周径（11.4±2.1）cm,外形接近正常阴茎。皮肤感觉恢复良好,阴茎头部两点分辨觉为5～12 mm,平均7 mm;采用DIEP法阴茎再造2例勃起硬度3级功能,能满足性生活部分要求;另1例阴茎勃起功能2级,未能进行性生活。结论：包皮环切术后微波治疗可导致阴茎坏死,后果严重,应高度重视。阴茎坏死发生后,应尽早清创术,根据病变程度及患者需求,可选择性行阴茎延长术或阴茎再造术。Objective：To investigate the pathogenesis and treatment of penile necrosis resulting from microwave diathermy following circumcision.Methods：We retrospectively analyzed the clinical data about 9 cases of penile necrosis resulting from postoperative microwave diathermy following circumcision.The 9 males,aged 20- 39（ mean 26） years,underwent traditional circumcision for redundant prepuce or phimosis in other hospitals,followed by microwave diathermy for 30- 60 minutes daily,which resulted in penile necrosis.With no response to conservative therapy,the patients were referred to our hospital at 3- 30 days postoperatively.Of the 9patients,5 presented with dry gangrene and 4 with moist gangrene.Six of the patients underwent partial penectomy,including 1 that received penis lengthening 3 months later,while the other 3 underwent total penectomy for total penile necrosis followed by penile reconstruction 3 months later,with deep inferior epigastric perforator（ DIEP） flaps and by implantation of the 12 th costal cartilage in 2cases and with epigastric groin island flaps and by urethroplasty in the other.Results：The patients were followed up for 2- 8 years,and all could urinate smoothly in the standing position.Of the 6 men treated by partial penectomy,1 received penis lengthening and achieved a penile length of 7 cm and 5 had the remaining penile length of 3- 5 cm,4 with erectile function and the other 2 capable of sexual intercourse.The 3 men treated by total penectomy achieved nearly normal external appearance of the penis,with a finalized length of（11.7± 1.3） cm,a circumference of（11.4 ± 2.1） cm,and a normal feel of the skin.Of the 3 cases of penile reconstruction,2 achieved sufficient erectile hardness of the penis（grade 3） for sexual intercourse,while the other 1 remained impotent.Conclusion：Post-circumcision microwave diathermy may result in penile necrosis,for the management of which,early debridement is necessitated and penile lengthening or reconstruction can be performed according to

关 键 词：阴茎 坏死 微波 热疗 禁忌证 

分 类 号：R699.8[医药卫生—泌尿科学]