阴茎白膜破裂修补术切口选择的探讨  

Surgical repair of the tunica albuginea for penis fracture: Selection of incision

作　　者：茅原申[1] 花豹 潘惟昕[1] 李文峰[1] 顾豫飞[1] 姚海军[1] 蔡志康[1] 王忠[1] 陆超[1] MAO Yuan-shen;HUA Bao;PAN Wei-xin;LI Wen-feng;GU Yu-fei;YAO Hai-jun;CAI Zhi-kang;WANG Zhong;LU Chao(Department of Urology, Shanghai Ninth People＇s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201999, China)

机构地区：[1]上海交通大学医学院附属第九人民医院泌尿外科,上海201999

出　　处：《中华男科学杂志》2018年第4期331-334,共4页National Journal of Andrology

摘　　要：目的:探讨阴茎折断的诊断和治疗。方法:1993年6月至2017年5月,我院共收治阴茎折断46例,平均年龄33.5岁(25~42岁),病程平均3.45 h(1~10h)。性交时发生41例,手淫4例,俯卧睡觉时发生1例。均无排尿困难及尿道口出血,4例发生了血尿,血肿局限于阴茎。45例在腰麻下行急诊手术治疗,1例局部麻醉下手术,16例采用冠状沟近侧环行切口,30例根据B超显示的破裂位置采用局部纵形纵切口。术中发现白膜破口平均1.31 cm(0.5~2.5 cm),6例采用丝线"8"字缝合白膜裂口,18例改用3-0可吸收线缝合白膜。常规放置皮片或负压引流管,留置导尿,早期使用纱布加压包扎,近年使用弹力绷带加压包扎3~5d,应用抗生素预防感染。术后1周拆线并拔除导尿管。结果:46例均行急诊手术修补,术后环形脱套切口的16例患者中,14例短期内发生了包皮水肿,而采取局部切口的患者则没有任何并发症,远期随访到的28例阴茎勃起功能均保持良好,无痛性勃起,能维持满意性交。结论:大多数阴茎折断局部纵行的小切口足以保证手术顺利完成,损伤小,不破坏血供和淋巴回流,不易发生手术并发症,相比环形脱套切口,优势明显,但如需探查尿道海绵体,应采用冠状沟下方的环形脱套式切口。Objective： To investigate the diagnosis and management of penile fracture. Methods： From June 1993 to May 2017, 46 cases of penile fracture were treated in our hospital, averaging 33.5 （25 - 42） years of age and 3.45 （ 1 - 10） hours in du- ration, of which 41 occurred during sexual intercourse, 4 during masturbation and 1 during prone sleeping, 4 with hematuria, but none with dysuria or urethral bleeding. Hematoma was confined to the penis. Emergency surgical repair was performed for all the patients, 45 under spinal anesthesia and 1 under local anesthesia, 16 by coronal proximal circular incision and the other 30 by local longitudinal incision according to the rupture location on uhrasonogram. The tunica albuginea ruptures averaged 1. 3 1 （0.5 - 2.5 ） cm in length, which were sutured in the ＂8＂ pattern for 6 cases and with the 3 -0 absorbable thread for 18 cases. The skin graft or negative pressure drainage tube was routinely placed, catheters indwelt, and gauze used for early pressure dressing. In the recent few years, elastic bandages were employed for 3 - 5 days of pressure dressing and antibiotics administered to prevent infection. The stitches and catheter were removed at 7 days after surgery. Results： Short-term postoperative foreskin edema occurred in 14 of the 16 cases of circular de- gloving incision, but no postoperative complications were observed in any of the cases of local incision. Twenty-eight of the patients completed a long-term follow-up of 49.4 （ 10 - 125） months, which revealed good erectile function, painless erection, and satisfactory sexual intel,eourse. Conclusion： For most penile fractures, local longitudinal incision is sufficient for successful repair of the tuniea alhuginea, with mild injury, no influence on the blood supply or lymph reflux, and a low rate complications. It therefore is obviously advantageous over circular degloving incision except when the cavernous body of urethra is to be explored, which necessitates circular degloving incision below th

关 键 词：阴茎白膜破裂 手术切口 并发症 

分 类 号：R697.15[医药卫生—泌尿科学]