显微镜下白膜斑块电动磨削及移植物修补术治疗阴茎硬结症21例报告  

Microscopic electric rotary grinding combined with graft repairing in patients with Peyronie’s disease:a report of 21 cases

作　　者：金大春 罗勇 王鹏 张勇 毕罡 童大力 王议鹤 周婉怡 李彦锋 JIN Dachun;LUO Yong;WANG Peng;ZHANG Yong;BI Gang;TONG Dali;WANG Yihe;ZHOU Wanyi;LI Yanfeng(Department of Urology,Army Medical Center of PLA,Chongqing,400042,China)

机构地区：[1]陆军特色医学中心泌尿外科,重庆400042

出　　处：《陆军军医大学学报》2024年第11期1291-1297,共7页Journal of Army Medical University

摘　　要：目的探讨在显微镜下应用电动磨钻进行白膜斑块磨削后,应用睾丸鞘膜或牛心包进行修补治疗阴茎硬结症的手术技巧和经验。方法采用回顾性队列研究方法,收集我院于2021年1月至2023年5月收治的因阴茎硬结症导致阴茎严重弯曲并行显微镜下白膜斑块电动磨削及移植物修补术治疗的21例患者的临床资料和信息,观察其短期和中期疗效。结果本组21例患者中12例(57.1%)采用单侧鞘膜修补,3例(14.3%)采用双侧鞘膜修补,6例(28.6%)采用牛心包修补。手术时长(272±69)min,术后随访(12.1±7.2)个月。17例(81.0%)患者勃起时阴茎完全伸直,无弯曲,无缩窄,4例(19.0%)略有背侧弯曲,但弯曲度<10°,患者均对其阴茎勃起时形态满意。术后测量阴茎长度变化[+(1.1±0.5)]cm,9例(42.9%)诉术后早期存在阴茎头感觉麻木感,持续(3.2±1.9)个月后自行消失。患者均能够顺利完成性生活,阴茎勃起硬度评分为3.8分。手术后整体满意率为90.5%。结论显微镜下Buck’s筋膜的精细分离有利于可靠保护阴茎背侧神经血管;应用电动磨钻进行白膜斑块的磨削可更加充分而精准地松解白膜;应用睾丸鞘膜或牛心包进行白膜缺损修补治疗阴茎硬结症总体效果良好,患者综合满意度高,值得推广应用。Objective To explore the surgical techniques and experiences in the treatment of Peyronie’s disease using electric rotary grinding of tunica albuginea plaques followed by graft repair with tunica vaginalis or bovine pericardium under a microscope.Methods A retrospective cohort study was performed on 21 patients with severe penile curvature due to Peyronie’s disease admitted in our department from January 2021 and May 2023.All of them underwent microscopic electric rotary grinding of tunica albuginea plaques followed by graft repair surgery.Short-term and mid-term outcomes were observed.Results For the 21 enrolled patients,12(57.1%)underwent repair using unilateral tunica vaginalis,3(14.3%)underwent repair using bilateral tunica vaginalis,and 6(28.6%)underwent repair using bovine pericardium.The operation time was 170~385(average 272±69)min,and the average postoperative follow-up duration was 3~24(average 12.1±7.2)months.Seventeen patients(81.0%)had their penis fully extended,while 4 patients(19.0%)had slight dorsal curvature,which was less than 10°.All patients were satisfied with the shape of their penis during erection.The change in penile length was+(1.1±0.5)cm,and 9 patients(42.9%)reported early postoperative penile head numbness,which spontaneously resolved after an average duration of 3.2±1.9 months.All patients were able to successfully engage in sexual activity,with an average penile erection hardness score of 3.8.The overall satisfaction rate was 90.5%postoperatively.Conclusion Meticulous dissection of Buck’s fascia under a microscope is advantageous in reliably preserving dorsal neurovascular structures.Application of an electric grinding drill for plaque ablation allows for more precise release of the tunica.Graft repair of tunica albuginea defects with testicular tunica vaginalis or bovine pericardium for Peyronie’s disease yields overall favorable clinical outcomes and obtains high satisfaction.It is worthy of promotion in clinical practice.

关 键 词：阴茎硬结症 阴茎畸形 显微技术 电动磨削 睾丸鞘膜 

分 类 号：R181.23[医药卫生—流行病学] R628[医药卫生—公共卫生与预防医学] R697.17