阴茎再造术中阴茎头成形方案的选择  

Selection of balanoplasty in penile reconstruction

作　　者：刘恒鑫 董玉林 刘超华 董立维 郝冬月 夏文森 Liu Hengxin;Dong Yulin;Liu Chaohua;Dong Liwei;Hao Dongyue;Xia Wensen(Department of Plastic Surgery,Xijing Hospital,the Air Force Military Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学西京医院全军整形外科研究所,西安710032

出　　处：《中华整形外科杂志》2020年第8期866-871,共6页Chinese Journal of Plastic Surgery

基　　金：西京医院学科助推计划(XJZT18ML44)。

摘　　要：目的:探讨游离前臂皮瓣阴茎再造术中阴茎头成形方案的选择策略。方法:2010年10月至2015年10月空军军医大学西京医院全军整形外科研究所收治20例行游离前臂皮瓣再造阴茎的患者,年龄19~41岁,其中易性病(女变男)14例,两性畸形3例,先天性阴茎发育不良2例,外伤后阴茎缺损1例。术中根据患者前臂皮瓣组织量及阴茎头发育情况等不同的术区条件,分别采用游离前臂皮瓣末端+山形肋软骨支架阴茎头成形、游离足背皮瓣+山形肋软骨支架阴茎头成形或阴茎头游离移植3种方法进行阴茎头再造,术后对患者进行长期随访,观察阴茎头形态的变化。结果:20例中18例采用游离前臂皮瓣末端+山形肋软骨支架再造阴茎头,1例易性病患者采用游离足背皮瓣+山形肋软骨支架再造阴茎头,1例两性畸形患者采用自体阴茎头游离移植再造。术后随访10~36个月,再造阴茎头全部成活,其中足背皮瓣再造的阴茎头形态最为饱满、自然,冠状沟清晰;前臂皮瓣再造的阴茎头组织量稍显不足,冠状沟稍平,总体形态满意;阴茎头游离移植再造的阴茎头保留了其形态,外形逼真,但不够饱满。结论:前臂皮瓣组织量较充足者采用游离前臂皮瓣末端+山形肋软骨支架、前臂组织量严重不足者采用游离足背皮瓣+山形肋软骨支架、自身阴茎头发育良好的两性畸形患者采用自体阴茎头游离移植再造,针对患者不同情况,个性化选择成形方法有利于获得满意的阴茎头外观。Objective To investigate the strategy of balanoplasty in penile reconstruction with free forearm flap.Methods From October 2010 to October 2015,20 patients(19-41 years old)underwent penile reconstruction with free forearm skin flap in Xijing Hospital of Air Force Military Medical University,including 14 cases of transexuals(female to male),3 cases of hermaphroditism,2 cases of congenital penile dysplasia and 1 case of penile defect after trauma.According to the tissue quantity of forearm flap and the development of glans,three methods were adopted to reconstruct the glans:free forearm skin flap+E-shaped cartilage framework,free dorsalis pedis flap+E-shaped cartilage framework or free glans transplantation.The patients were followed up for a long time postoperation to observe the morphological changes of the glans after different method of balanoplasty.Results Among the 20 patients,18 cases were treated with distal part of free forearm flap and E-shaped cartilage framework for glans reconstruction,1 case of transexuals used free dorsalis pedis flap and E-shaped cartilage framework for glans reconstruction,and 1 case of hermaphroditism used free glans transplantation to reconstruct glans.After 10-36 months of follow-up,all reconstructed penises survived.The shape of glans reconstructed by dorsalis pedis flap was the most plump and natural with clear coronal sulcus;the amount of glans tissue reconstructed by forearm skin flap was slightly insufficient,and the coronal sulcus was slightly flat,while the overall shape was satisfactory.The reconstructive glans with free glans transplantation was not plump,but they retained the shape of glans,which was lifelike.Conclusions If the tissue quantity of forearm skin flap is sufficient,the distal part of free forearm flap and E-shaped cartilage framework is used;if the tissue quantity of forearm is seriously insufficient,the free dorsalis pedis flap and E-shaped cartilage framework is used.For hermaphroditism patients with well-developed glans,autologous glans free transplanta

关 键 词：阴茎 外科皮瓣 移植物 阴茎再造术 阴茎头成形术 肋软骨 移植 阴茎头 

分 类 号：R699.8[医药卫生—泌尿科学]