睾丸假体植入术治疗睾丸缺失的安全性与有效性临床观察(附18例报告)

目的:探讨采用国产中空硅胶睾丸假体实施睾丸假体植入术,治疗睾丸缺失的安全性和有效性。方法:自2009年1月至2011年3月,选择18例睾丸缺失者行睾丸假体植入术,包括:前列腺癌睾丸去势术10例、先天无睾症3例、单侧睾丸萎缩2例、两性畸形2例、隐睾症1例。睾丸假体为YH-G1型国产中空硅橡胶假体,睾丸假体的大小根据患者阴囊可容纳的空间及参照对侧睾丸的体积来选择。结果:18例中有13例一期行假体植入,另5例植入时间在睾丸切除6个月后。平均睾丸假体植入术的手术时间为(22.6±4.6)min(15～30 min),所有患者术后留院观察12 h后即出院,住院时间(1.3±0.4)d。17例术后无感染、出血和排异等并发症发生。1例前列腺癌去势术患者在睾丸假体植入术后3个月时出现排异,最终取出睾丸假体。术后6个月随访:15例对假体的大小感到非常满意,2例认为植入的假体偏小;14例对植入假体的重量感到非常满意,3例认为植入的假体偏轻;17例患者对植入假体后阴囊的形状和假体的位置表示满意;12例患者反映无论是在活动后还是在睡眠中睾丸假体的舒适度良好,5例患者认为植入的假体偏硬。结论:新型YH-G1型国产中空硅胶睾丸假体治疗男性睾丸缺失能满足患者外观及心理的需要,临床实验表明安全有效,并发症少。长期生活质量及并发症还需进一步观察,设计更舒适及有功能的缓释型睾丸假体还需进一步研究。

Safety and effectiveness of testicular prosthesis implantation for testis loss: clinical observation of 18 cases

Objective: To investigate the effect and safety of the implantation of a new type of testicular prosthesis in the treatment of testis loss.Methods: We recruited for this study 18 patients with testis loss treated by testicular prosthesis implantation,including 10 cases of prostate cancer,3 cases of anorchia,2 case of orchiatrophy,2 cases of hermaphroditism and 1 case of cryptorchidism.The prosthesis was a hollow silicone elastomer YH-G1 made in China,selected according to the volume of the scrotum and the size of the contralateral testis.Results: Thirteen of the patients received testicular prosthesis implantation with orchiectomy,and the other 5 underwent the procedure 6 months later.The operation time of testicular prosthesis implantation was(22.6 ± 4.6) min,ranging from 15 to 30 minutes.All the patients were discharged after 12 hours of postoperative observation,with a mean hospital stay of(1.3 ± 0.4) days.A follow-up after 6 months revealed no complications in 17 cases.Rejection occurred in 1 case at 3 months after the implantation,ending in the removal of the prosthesis.Of the 17 successful cases,15 were very satisfied with the size of the prosthesis,14 with its weight,12 with its comfortableness,and all with the appearance of the scrotum and the position of the prosthesis,while 5 found the implant too rigid.Conclusion: The implantation of the new home-made silicone elastomer testicular prosthesis YH-G1 was safe and effective for the treatment of testis loss,and could meet the esthetic and psychological requirements of the patient.But further observation is needed for its long-term complications and influence on the patient’s quality of life.