正常成人阴茎及其毗邻组织结构的可视化研究

目的建立正常成人阴茎及其毗邻结构的数字化可视模型，为阴茎整形修复获得手术前后形变参数及手术方案的选择，提供形态学依据。方法采用第三军医大学解剖学教研室建立的数字化可视人体数据集（chinese visible human，CVH）部分连续图像，运用表面绘制的方法，对阴茎及其毗邻组织结构进行计算机三维重建和立体显示。结果可视化模型可清晰显示阴茎内部及毗邻结构的形态、分布特点和相互间的三维空间解剖关系。重建图像能单独或联合显示，并可进行任意径线和角度的适时三维测量。结论阴茎可视化模型能够准确反映出该区域复杂的解剖学特点及其内部空间毗邻关系，可为成人阴茎整形修复外科手术提供重要的形态学数据来源。     

成人阴茎整形修复的3D手术仿真研究

目的:在3D虚拟环境中实现成人阴茎整形修复手术的模拟过程,达到术前制订定量化的手术方案,术后客观地评价疗效。方法:利用计算机三维重建成人阴茎及毗邻结构可视化模型,将阴茎整复手术过程在计算机上实现模拟操作。结果:在3D环境中,实现成人阴茎整形修复术的仿真模拟和手术方案的制订。结论:本研究为成人阴茎整形修复定量化手术设计、选择最佳手术入路及术后疗效评价提供了新的技术方法,为整形外科教学培训、多学科及远程会诊提供了新的工具。     

基于力反馈和快速成型技术的成人阴茎虚拟手术仿真研究

目的探讨力反馈基础上辅助3D快速成型技术进行成人阴茎虚拟手术仿真研究,为提高手术成功率、减少并发症提出方法。方法2009年1月至2015年12月,内蒙古医科大学附属医院整形美容烧伤科选取内蒙古汉族成年男性20例(20~50岁),将受试者从髂嵴上缘到阴茎下缘的连续CT二维数据导入计算机,用Magics RP软件,三维重建阴茎及毗邻结构,用快速成型技术制作出阴茎及毗邻结构的快速成型(Rapid-prototyping,RP)模型。在Free Form系统下,基于力反馈设备进行成人阴茎数字化虚拟仿真修复手术操作。结果用Free Form系统进行成人阴茎虚拟整形修复手术,在阴茎三维立体模型上随意操作,为定量化手术设计、选择最佳手术入路、最大可能避免并发症的发生提供新的技术手段。结论阴茎RP模型能较准确反映该区域复杂的解剖学特点及其内部空间毗邻关系,在力反馈基础上,使医师从视觉、听觉和触觉感知仿真手术过程,为精准进行成人阴茎修复手术提高临床应用价值。     

阴茎海绵体延伸加带蒂皮瓣转移治疗不完全性阴茎缺损(附42例报告)

目的　探讨具有感觉与勃起功能的阴茎修复方法治疗阴茎不完全性缺损。　方法　①手术方法 :离断全部浅、深悬韧带 ,分离部分海绵体脚 ,使阴茎更为延伸 ;用含血运的脂肪瓣转移填塞耻骨前间隙 ,保证术后远期阴茎的有效长度 ;选用合适的带蒂皮瓣转移覆盖海绵体 ,塑造外形更为美观的阴茎体部 ;阴茎残端整形塑造逼真的阴茎头和冠状沟样外观。②术后随访方法 :对术后患者取移植皮瓣全层皮肤 ,分别进行光镜、免疫组化、透射电镜和扫描电镜等检测 ,观察皮肤神经再生情况 ;通过对修复阴茎皮肤的触觉、痛觉及两点分辨觉 (复合感觉 )的检测 ,了解感觉功能恢复情况 ;采用夜间阴茎勃起测定系统检测阴茎修复后的勃起功能。　结果　①修复阴茎 4 2例 ,术前残留阴茎常态下长度 0 .5～ 4 .0cm ,勃起时长度 1.5～ 5 .0cm ;术后常态下长度 5 .0～ 8.0cm ,勃起时长度 7.0～ 12 .5cm ;随访 1年以上者 2 8例 ,已婚 2 3例 ,性生活基本满意 ,已育 18例。②移植皮瓣术后 12个月光镜观察 ,真皮层内可见末梢神经束 ;免疫组化标记神经纤维束的细胞浆内可见神经纤维细丝蛋白阳性颗粒 ;透射电镜和扫描电镜均可见再生的神经纤维束及相关组织。修复阴茎已有触觉、痛觉及两点分辨觉。③勃起功能测定 :术后 12个月以上患者夜间 8～ 12h内勃     

3D扫描在海绵体内血管活性药物注射试验诊断勃起功能障碍中的应用初探

目的初步探讨3D扫描技术在海绵体内血管活性药物注射试验(ICI)诊断勃起功能障碍中的作用。方法对我院男科门诊行ICI的患者,在检查过程中通过手持式3D扫描仪进行阴茎的3D扫描,收集患者药物注射前后阴茎形态学的数据并与ICI结果进行相关性分析。结果通过3D扫描测量,患者在ICI诱发阴茎勃起后,阴茎长度增加(42.07±11.55)cm,阴茎根部直径增加(7.29±5.44)cm,阴茎根部周长增加(25.21±15.71)cm,阴茎头部直径增加(5.56±3.67)cm,阴茎头部周长增加(17.99±14.22)cm,角度增加(41.60±32.60)°。患者通过3D扫描所测量的勃起角度与肉眼估计的角度范围一致,但更精确。不同硬度分级组之间只有勃起前后角度(3D)差值和勃起后角度(ICI)的差异有统计学意义(P0.001)。结论 3D扫描可以为ICI提供丰富的有关阴茎勃起前后大小和角度的定量信息。     

阴茎毁损性烧伤的修复与重建

目的 总结毁损性深度烧伤所致阴茎缺损的修复和重建经验. 方法 对24例烧伤后早期或晚期(指创面愈合半年后.下同)阴茎长度缺失患者行修复手术.术中切断阴茎悬韧带,使缺损阴茎残端向前延伸以获得足够长度,分别用下腹壁皮瓣、阴囊皮瓣或阴股沟皮瓣修复阴茎延长后创面.其中10例患者于伤后30 d内手术,14例于晚期手术.观察患者术后皮瓣成活及并发症发生情况;于手术前及治愈后随访时,测量患者常态下及勃起状态下阴茎的长度;随访了解患者阴茎皮肤感觉功能恢复情况、阴茎勃起功能及性生活满意度. 结果 24例患者中,2例术后皮瓣远端分别出现1.0 cm×0.5 cm和1.5 cm × 1.0 cm部分坏死,经换药后愈合,其余皮瓣均完全成活.所有患者随访2～5年,常态F阴茎长度为(7.4±1.6)cm,较术前延长(5.3±1.4)cm(P<0.01);勃起时长度达(9.7±1.2)cm.阴茎感觉均在术后半年左右逐步恢复,勃起功能良好.除1例未再尝试性生活外,其余已婚患者及其配偶均感性生活满意或基本满意. 结论 对毁损性烧伤所致阴茎缺损,采用阴茎延长结合皮瓣移植,可保留阴茎的适当长度和性功能,是较好的治疗方法 .     

保留感觉与勃起功能的阴茎再造术

目的 对阴茎因外伤致全部或大部分缺损的患者,利用阴茎海绵体延伸术和皮瓣转移术再造有感觉与勃起功能的阴茎。方法 切断阴茎浅、深悬韧带并分离部分海绵体脚以延伸阴茎海绵体;同时利用阴茎残端再造阴茎头;选用各种皮瓣覆盖阴茎创面。结果 采用所述方法行阴茎再造40例,术前残留阴茎常态下长度0．5～4．0cm,勃起时长度1．5～5．0cm;术后常态下长度5．0～8．5cm,勃起时长度7．0～12．5cm;术后均具有感觉和勃起功能。结论 利用本法再造之阴茎不但在长度和形态上已接近正常,更重要的是具备良好的感觉与勃起功能,从而替代了传统的阴茎再造术,是修复阴茎大部或全缺损较为理想的方法。     

阴茎海绵体内注射国产前列腺素E_1治疗功能性阳萎

前列腺素E_1(PGE_1)具有松弛阴茎海绵体肌肉和抑制肾上腺能活动的能力,这一现象被认为是阴茎勃起的主要机理。45例功能性阳萎病人采用国产PGE_1阴茎海绵体内注射治疗,能达到迅速与暂时的阴茎勃起。注射后,阴茎长度增加3.87～4.07厘米,阴茎周径增加3.60～3.70厘米,和具有一个平均91.1°～93.0°的勃起角度。勃起保持时问平均65分钟。阴茎硬度测量分析:大于75点41例,性交能力恢复;50～75点4例,性交失败。总的成功率91.1％。没有发现严重副反应和阴茎持续勃起。PGE_1注射技术能用于阳萎治疗,尤其适用于自我注射病人。     

阴茎悬吊系统在隐匿性阴茎矫治手术中的解剖应用(附56例报道)

目的探讨研究阴茎悬吊系统作为解剖标记在隐匿性阴茎矫治手术中的临床应用。方法回顾性分析2019年7月至2021年12月在本院经手术治疗的56例隐匿性阴茎患者的临床资料, 所有患者均实施隐匿性阴茎矫治手术, 术中利用阴茎悬吊系统作为解剖标记, 将阴茎皮肤逆向脱套至阴茎体根部背侧正中的阴茎悬韧带及呈"U"型包绕阴茎根部的袢状韧带, 切断阴茎悬韧带浅部, 从而充分释放阴茎海绵体, 然后以袢状韧带作为水平标记线, 于阴茎体根部1点和11点处将阴茎白膜缝合固定于耻骨联合前部皮肤的真皮层, 以重建阴茎-腹壁角进一步改善阴茎显露效果, 术中注意保护袢状韧带、阴茎悬韧带深部及耻骨弓状韧带, 保障阴茎术后勃起的稳定性和勃起角度。结果所有患者均顺利完成手术, 手术时间为(78.0±6.5)min, 术前疲软状态时的阴茎长度为(2.2±0.6)cm, 术后1个月复查疲软状态时的阴茎长度为(5.6±0.4)cm, 患者术后阴茎长度较术前增加(P<0.05), 所有患者均对术后阴茎外观显露非常满意, 阴茎勃起时与腹壁夹角均<90 °, 且可稳定维持勃起角度和方向;对48例已有性生活的成年患者分别于术前...     

上海市990例婚龄男子阴茎、睾丸测量结果分析

在婚前体检工作中,对900例年龄23～35岁的正常男性阴茎,睾丸进行了测验。其结果:睾丸体积为15.68±5.03ml;常态下阴茎长度为6.9±1.4cm,直径为2.5±0.3cm;负压被动勃起状态下阴茎长度为11.6±1.7Cm,直径为3.3±0.4cm。简要讨论了睾丸体积,阴茎长度和直径与受检者年龄、身高和体重的关系。本组测量值可作为上海婚龄男子睾丸,阴茎正常值参考数据。     

Effect of erythropoietin on sexual potency in chronic haemodialysis patients. A preliminary study.

Six male dialysis patients were submitted to a Doppler study of the deep penile arteries and intracavernosal injection of 30 mg papaverine under basal conditions before and after erythropoietin therapy. Penile tumescence was recorded after 15 min by measuring the length and the circumference of the penis as well as the erectile angle between the penis and the legs with the patient in standing position. Haematocrit was raised by erythropoietin therapy from 19.3 +/- 4.5 to 31.2 +/- 5.5 within 3 months. Five patients completed the study. We encountered a significant improvement in the frequency of sexual intercourse per month from 1.3 +/- 0.5 to 2.3 +/- 0.8 (p = 0.014). Furthermore, an increase was observed in the penile brachial index (from 0.87 +/- 0.1 to 0.91 +/- 0.1) and in the papaverin induced increase in penile length (4.6 +/- 1.4 cm versus 5.2 +/- 1.1 cm), penile circumference (2.7 +/- 0.14 cm versus 2.7 +/- 0.27 cm) as well as in the erectile angle (61.7 +/- 37.1 versus 80 +/- 23.5 degrees). These changes were not statistically significant. There was a significant correlation between the increase in the erectile angle and the increase in frequency of intercourse (p = 0.04). In conclusion, erythropoietin treatment could improve the sexual potency in uraemic patients under chronic haemodialysis therapy.     

Induratio penis plastica (IPP)

Peyronie's disease is a benign disorder of the penis but the etiology is still unknown. A wound healing disorder after repetitive microtraumatic lesions with inelastic scar formation of the tunica albuginea potentially leads to the typical symptoms of penile plaque formation, penile pain, deviation and erectile dysfunction. A non-surgical therapy based on a clear pathophysiology does not exist although the benefit of several conservative treatment options is under discussion. In the stable stage of the disease patients with Peyronie's disease frequently undergo penile surgery. Depending on the deviation angle, the penile length and the erectile dysfunction different straightening surgery can be performed. This article provides an overview of the natural history of the disease and describes present conservative management strategies and common surgical techniques for penile straightening.     

Surgical treatment of Peyronie＇s disease： choosing the best approach to improve patient satisfaction

Aim： To discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyronie＇s disease. Methods： Recent advances in approaches to Peyronie＇s disease are discussed based on the literature and personal experiences. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed. Lengthening procedures on the convex side of the penile curvature by means of grafting offer the best possible gain from a reconstruction standpoint. Penile rectification and rigidity are required to achieve a completely functional penis. Most patients experience associated erectile dysfunction （ED）, and penile straightening alone may not be enough to restore complete function. Twenty-five patients were submitted to total penile reconstruction on length and girth with concomitant penile prosthesis implant. The maximum length restoration was possible and limited by the length of the dissected neurovascular bundle. The mean age was 55.4 years （32-69 years） and the mean angle of curvature 74.2± 22.4° （0-100°）. Pericardial grafting was used to cover the defect. The mean follow-up time was 11.2 ± 5.9 months （3-22 months）. Results： Mean functional penile length gain was 3.40 ＋ 0.73 cm （2-5 cm）. Penile prosthesis maintained the penis straight. No infections occurred. Sexual intercourse was restored in all patients and all reported recovered self-esteem. Conclusion： Improving patient satisfaction with the surgical treatment includes proper preoperative evaluation on stable disease, penile shortening, vascular and erectile status, patient decision and selection as well as extensive discussion on surgical technique for restoring functional penis （length and rigidity）. Length and girth restoration is very important for self-esteem and patient satisfaction.     

阴茎体白膜两侧睾丸鞘膜移植阴茎增粗术实验研究

目的:探讨犬阴茎体白膜两侧自体睾丸鞘膜移植阴茎增粗术的治疗效果及手术并发症。方法:取5只雄性杂种狗自体睾丸鞘膜移植于阴茎白膜两侧的纵形切口,以扩大阴茎白膜腔、增大阴茎海绵体容积、增粗阴茎;手术前后进行疲软及勃起状态下阴茎海绵体周径的测量及两侧阴茎海绵体动态灌注测压(DIC);术后3个月行组织学检查。结果:施行5只10侧,术后3个月勃起状态下阴茎海绵体周径平均增加21.1%,疲软状态下增粗不明显,DIC参数与术前相比无统计学差异;无其他严重并发症;组织学检查移植物内轻度炎性反应和纤维化,其上有白膜的重新形成。结论:该手术方法使勃起状态下阴茎增粗效果显著,是一种安全的、真正针对勃起组织的阴茎增粗方法。     

改良阴茎延长术的解剖学研究和临床应用

目的 对阴茎发育不良症患者,采用阴茎海绵体延伸术和脂肪瓣转移术充分延长短小的阴茎.方法 通过对男性会阴部结构的解剖学研究,了解阴茎悬韧带的厚度、阴茎脚剥离长度与稳定性的关系;通过离断阴茎浅、深悬韧带,并分离部分海绵体脚,使原固定于耻骨下支的阴茎海绵体充分分离,以使阴茎更为延伸;用含血运的脂肪瓣填塞耻骨前间隙,保证术后远期阴茎的有效长度.结果 2001至2009年采用上述方法行阴茎延长术205例,术前阴茎常态下平均长度4.26cm,勃起时平均长度8.13 cm,术后阴茎常态下平均长度8.63 cm,勃起时平均长度12.11 cm.结论 采用本方法可在不影响阴茎勃起时稳定性的前提下,使阴茎海绵体比以往的阴茎延长术多延伸1～2 cm,使之更加满足患者生理和心理上的需求.     

阴茎部整形术的应用解剖学研究

目的 探讨阴茎及其与邻近组织的解剖关系，为阴茎部整形术提供解剖学基础。方法 对30具(左右60侧)成年男性尸体的阴茎和会阴部进行解剖学观察，对阴茎各部的长度，漏斗韧带和悬韧带与阴茎根关系，阴茎海绵体脚与阴茎血管的关系进行观察和测量。结果 所测成人阴茎体长度为8．13cm；阴茎根长度为7．67cm，海绵体脚长度为5.96～5.98cm。漏斗韧带附着于阴茎根前部，阴茎浅筋膜两侧，并向下延伸为阴囊纵隔，参与组成阴囊和阴茎的悬吊结构；悬韧带附着于阴茎深筋膜背侧，后部增厚与耻骨弓状韧带紧密连结，参与尿道悬吊结构。在阴茎根部与阴茎海绵体脚部之间，有一段既无韧带附着又无骨性附着的海绵体，阴茎背动脉和神经在此处从腹侧转向背侧，阴茎背深静脉由此处穿过尿生殖膈注入盆腔内静脉丛。阴茎深动脉在海绵体脚骨性附着中部进入阴茎。结论 本组30例阴茎体长度的分区测量，阴茎悬吊结构的再认识及海绵体脚与阴茎深动脉的解剖关系对阴茎部整形手术具有重要意义。     

Penile lengthening

OBJECTIVE: To describe a technique for penile lengthening and the results achieved. PATIENTS AND METHODS: The penis is completely disassembled into its anatomical parts; the glans cap remains attached dorsally to the neurovascular bundle and ventrally to the urethra and corporal bodies. A space is created between glans cap and the tip of corpora cavernosa; this space is used to insert autologous cartilage previously harvested from the rib, the space being measured beforehand when the corpora cavernosa are erect. The anatomical entities and inserted cartilage are joined together to form a longer penis. The increased length of the penis depends directly on the elasticity of the urethra and especially of the neurovascular bundle. From June 1995 to March 1999 the technique was applied in 19 patients aged 18-52 years, who were followed for a mean (range) of 3.3 (1-4.5) years. RESULTS: The increase in penile length was moderate, at 2-4 cm; there were no injuries of the neurovascular bundle or urethra, and no erectile dysfunction. Fifteen patients reported painless sexual intercourse, the remaining four patients providing no data. During the follow-up the cartilage insert remained at about the same size as that at initial implantation. CONCLUSION: The penile disassembly technique combined with the interposition of rib cartilage in the space between the glans cap and tips of the corpora cavernosa provides a genuine increase in penile length, with satisfactory results.     

The erectile angle: objective criterion to evaluate the papaverine test in impotence

Intracavernous papaverine injection may be the first diagnostic step in the assessment of the impotent patient. However, the appreciation of its effect must rely on the evaluation of penile rigidity. Since measurement of rigidity requires a sophisticated procedure that may not be available to the majority of practitioners, we attempted to find a simple and objective method to evaluate the results of this common test. We tested 50 patients complaining of impotence with intracavernous injection of 60 mg. papaverine. The length and circumference of the penis were measured before and after papaverine injection. The rigidity was determined by measuring the angle between the penis and the legs with the patient in the standing position. Afterwards, each patient underwent vascular (Doppler ultrasound and cavernometry) and neurological examinations. A total of 27 patients with no vascular abnormalities had an erectile angle of 96 degrees (range 90 to 130 degrees), while 23 patients had some vascular disorders (9 arterial lesions, 8 venous leakage and 6 combined lesions) and an erectile angle of 36 degrees (range 0 to 60 degrees). There was no significant difference between the groups in the increase of length and circumference of the penis after intracavernous injection of papaverine. The papaverine test can distinguish between patients with vascular and psychogenic problems. A negative papaverine test associated with a normal Doppler examination is characteristic of venous leakage. Measurement of the erectile angle after intracavernous injection of papaverine with the patient in the standing position is a simple, objective and reliable method to evaluate patients with vascular impotence.