阴茎及双侧睾丸完全离断显微再植术1例报告并文献复习  

A case report of micro-surgical replantation of completely disconnected penis and bilateral testes and literature review

作　　者：刘旭东 李彦锋[1] 李中泰[1] 张勇[1] 罗勇[1] 冯庆兴[1] 黄灶明[1] 江军[1] LIU Xu-dong;LI Yan-feng;LI Zhong-tai;ZHANG Yong;LOU Yong;FENG Qing-xing;HUANG Zao-ming;JIANG Jun(Department of Urology,Daping Hospital,Research Institute of Surgery,Medical University,Chongqing 40042,China)

机构地区：[1]陆军军医大学大坪医院野战外科研究所泌尿外科

出　　处：《现代泌尿外科杂志》2019年第6期451-454,479,共5页Journal of Modern Urology

摘　　要：目的总结我院收治的1例阴茎及双侧睾丸完全离断患者的治疗经验并进行相关文献回顾,以期提高对该类患者的临床诊治水平。方法本例患者因自残导致阴茎及双侧睾丸完全离断,入院后立即完善术前准备后行阴茎及双侧睾丸显微再植手术。术后予以强力抗感染、镇痛、抗抑郁、改善微循环、高压氧等治疗。结果术后6月内随访观察,患者阴茎存活,可正常站立排尿,最大尿流率20mL/s。双侧睾丸存活但体积有较明显萎缩。患者经雄激素替代治疗后,阴茎有明显勃起功能存在。结论临床上阴茎、睾丸完全离断伤极为罕见,应力争迅速进行再植手术。术中应用显微外科技术进行精细的血管和神经吻合是手术成功的基础,术后强力抗感染、镇痛、抗抑郁、改善微循环、高压氧等综合治疗对于再植器官的成活和功能恢复极为关键。Objective To improve the clinical management by summarizing the treatment experience of a rare case of complete amputation of penis and bilateral testes and reviewing the relevant literature. Methods The patient s penis and bilateral testes were completely disconnected due to self-mutilation.The micro-surgical replantation of penis and bilateral testis were performed immediately after the patient was admitted.Postoperative treatment included strong anti-infection,analgesia,anti-depression,improvement of microcirculation and hyperbaric oxygen. Results Follow-up observation within 6 months after operation showed that the patient s penis survived and the patient could urinate normally in the standing position,with a maximum urinary flow rate of 20 mL/s.Both testes survived but atrophied significantly.The penis had obvious erectile function after androgen replacement therapy. Conclusion Complete amputation of the penis and testis is extremely rare in clinical practice.Timely replantation is essential.Fine anastomosis of blood vessels and nerves with microsurgical techniques is the basis of successful operation.Comprehensive postoperative treatment including strong anti-infection,analgesia,anti-depression,improvement of microcirculation and hyperbaric oxygen is crucial for the survival and functional recovery of the replanted organs.

关 键 词：阴茎离断 阴茎损伤 睾丸离断 显微外科 再植 

分 类 号：R699.8[医药卫生—泌尿科学]