阴茎延长术后皮肤坏死的临床处理(附12例报告)

目的:分析阴茎延长术后皮肤坏死原因及相应的处理措施,观察游离皮片植皮治疗阴茎皮肤缺损的临床效果。方法:回顾性分析我科自2017年1月至2022年1月收治的12例阴茎延长术后阴茎皮肤大面积坏死缺损的病例资料。12例患者经过多种方式创面准备后行大腿中厚或全厚游离皮片植皮修复术。结果:12例患者植皮成活良好,切口均一期愈合,未发生二次感染坏死等并发症。术后随访6个月,阴茎植皮区域皮肤感觉大部分恢复,皮肤无明显破溃,水肿,阴茎外观满意。行IIEF-5、EHS量表评分及阴茎硬度检测结果反应勃起功能情况,均提示勃起功能正常。结论:阴茎皮肤大面积坏死行自体中厚或全厚游离皮片植皮修复术临床疗效满意,可有效解决阴茎延长术后出现皮肤大面积坏死的严重并发症难题。     

阴茎纵形切口行阴茎延长术20例报告

目的：观察阴茎纵行切13成形阴茎延长术的临床效果。方法：采用阴茎纵行切口成形阴茎延长术治疗阴茎短小者20例。结果：术后所有患者均对手术效果满意，阴茎自然显露长度延长约3～5cm，勃起约4～8cm，随访2～3个月，无明显回缩，无脂肪液化和明显瘢痕形成，2例出现皮肤切口裂开，换成褥式缝合皮肤后再无发生，术后均有不同程度的包皮水肿，1～2个月后逐渐消退。手术平均时间约35min。结论：阴茎纵行切口成形阴茎延长术临床效果满意。     

阴茎延长术并发症分析与处理

目的：分析总结阴茎延长术后并发症及其处理方法。方法：16例阴茎延长术后并发症包括感染、血肿、皮瓣坏死、包皮水肿和瘢痕增生等，应用手术、换药、理疗等分别进行了治疗。结果：16例并发症患者经不同方法治疗处理后均痊愈。结论：阴茎延长术后感染和皮瓣坏死者阴茎延长效果差，其他并发症对阴茎延长的效果影响较小。     

正常男性的阴茎延长术

目的：探讨应用耻骨上倒U形切口、阴茎背侧浅悬韧带及部分深悬韧带切断的方法对正常男性阴茎延长的效果。方法：总结8年来收集的130例阴茎短小患者的资料,年龄16～53岁,平均年龄24岁,均采用同样的阴茎延长术式。结果：130例全部成功,仅1例发生切口脂肪液化,经定期换药处理后愈合,术后静态长度平均延长2.5～4cm,勃起后长度平均延长2～3.5cm。术后随访6～12个月,患者对阴茎外形、长度均满意,其中,有性生活的患者对术后性生活质量满意度均有不同程度的提高。结论：应用耻骨上倒U形切口、阴茎背侧浅悬韧带及部分深悬韧带切断的方法行阴茎延长术,具有手术成功率高、术后并发症少、术后瘢痕隐蔽及效果满意的优点。     

阴茎离断再植术及术后并发症的防治

目的探讨提高阴茎离断再植术的成活率及减少术后并发症的防治方法。方法回顾分析4例阴茎离断再植术手术方法及术后处理措施的临床资料。结果 4例阴茎再植术均取得满意效果。1例出现远端阴茎皮肤坏死,行带蒂阴囊转移皮瓣植皮术。结论完善的院前急救措施及离断阴茎的保护、术中成功吻合阴茎背动脉静脉及神经、术后抗感染与防止血管痉挛是提高阴茎再植成活率和减少术后并发症的关键。     

蹼状阴茎的矫正

１９８８年５月至１９９７年９月,我科采用倒“Ｖ－Ｙ”及“Ｗ”成形术,共治疗先天性蹼状阴茎及阴茎延长术后并蹼状阴茎１２例,作者对手术方法,治疗效果及阴茎延长术后并蹼状阴茎的形成原因进行探讨。     

耻骨上V-Y切口阴茎延长术与冠状沟环切口+耻骨上抽脂阴茎延长(Sun's)术比较

目的:评估耻骨上V-Y切口阴茎延长术与冠状沟环切口+耻骨上抽脂阴茎延长术(Sun's阴茎延长术)的临床效果。方法:回顾性分析我院由同一组医师所行阴茎延长术病例100例,其中V-Y切口阴茎延长术(V-Y组)50例;Sun's阴茎延长术50例,对两组的体质量指数、术前阴茎静态与勃起长度、术后阴茎静态及勃起长度、手术时间、出血量、住院时间、镇痛药物使用情况、伤口Ⅰ期愈合率及术后并发症等指标进行统计分析。结果:两组患者平均年龄分别为23.5岁和23.0岁、体质量指数分别为(26.59±1.16)kg/m~2和(26.44±0.96)kg/m~2、术前阴茎静态长度分别为(5.11±0.30) cm和(5.12±0.35) cm、勃起长度分别为(7.57±0.65)cm和(7.35±0.59) cm、术后阴茎静态长度分别为(7.80±0.40) cm和(7.79±0.42)cm、勃起长度长度分别为(11.59±0.55)cm和(11.47±0.64) cm,组间差异无统计学意义(P0.05),但V-Y组在手术时间[108(90～120)min]、术中出血量[30(15～45)ml]、住院时间[8(6～11)d]、术后镇痛药物使用率(26.67%)、血肿发生率(23.33%)和感染率(20.00%)均显著高于Sun's阴茎延长术组[51(45～58)min、15(5～25)ml、4(2～6)d、3.33%、0%、0%,P0.01或P0.05];伤口的Ⅰ期愈合率显著低于后者(76.67%vs 100.00%,P=0.016)。V-Y组和Sun's阴茎延长术组术前性生活质量评分分别为(28.70±4.87)分和(28.27±3.40)分,无统计学差异(P0.05);术后分别为(36.73±5.41)分和(42.07±3.64)分(P0.05),术后两组性生活质量评分均显著高于术前(P0.01),但Sun's阴茎延长术组术后性生活质量评分显著高于V-Y组(P0.01)。结论:Sun's阴茎延长术在治疗成人阴茎短小疾病中具有创伤小、手术时间短、出血量少,术后并发症发生率较低的特点,在临床上有较高应用价值。     

改良阴茎延长加增粗术临床应用分析

目的：探索一种理想的阴茎延长术，同期增粗术式。方法：对10例阴茎短小症患者进行改良的阴茎延长加增粗术式即松解阴茎浅悬韧带，2个交错皮瓣加小阴囊皮瓣减张推进缝合方法；同期PTFE充填，阴茎增粗。结果：10例阴茎短小症患者术后伤口愈合良好，阴茎平均延长3．5～4．5cm，平均增粗2．O～2．5cm，外观改善满意，随访性生活满意。结论：该术式松解延长了阴茎皮肤，较经典的阴茎延长术式术后效果好，手术操作简单，容易掌握。     

包皮环切术后微波治疗致阴茎坏死9例报告

目的:探讨包皮环切术后微波治疗致阴茎坏死发生机制及处理原则。方法:回顾2006年5月至2011年11月9例包皮环切术后微波治疗致阴茎坏死临床资料。患者为男性,年龄20~39岁(中位年龄26岁),均在其他医院以包皮过长或包茎接受环切术,手术结束时未有阴茎缺血表现。术后1 h至3 d开始实施应用非接触式微波治疗。术后1~10 d出现阴茎坏死,伴感染4例。经换药等保守治疗无效,术后3~30 d来我院。9例中5例为干性坏疽,4例为湿性坏疽。6例为阴茎部分坏死,行阴茎部分切除术,其中1例于术后3个月接受阴茎延长术;其他5例未接受再手术。3例为全阴茎坏死,其中1例伴阴囊皮肤坏死;均在阴茎全切后3个月行阴茎再造术,其中2例行腹壁下深动脉穿支皮瓣(DIEP法)及自体第12肋阴茎支撑物植入;1例行髂腹股沟岛状皮瓣、阴囊皮管尿道成形术。结果:本组患者术后随访2~8年,均可站立排尿,排尿畅。1例于阴茎部分切除术后阴茎残留部3 cm,术后由3个月接受阴茎延长,阴茎长度延长至7 cm;5例未接受阴茎延长术,阴茎残端3~5 cm,其中4例有勃起功能,2例可进行性生活。3例行阴茎全切阴茎再造术,阴茎定型长度为(11.7±1.3)cm,周径(11.4±2.1)cm,外形接近正常阴茎。皮肤感觉恢复良好,阴茎头部两点分辨觉为5~12 mm,平均7 mm;采用DIEP法阴茎再造2例勃起硬度3级功能,能满足性生活部分要求;另1例阴茎勃起功能2级,未能进行性生活。结论:包皮环切术后微波治疗可导致阴茎坏死,后果严重,应高度重视。阴茎坏死发生后,应尽早清创术,根据病变程度及患者需求,可选择性行阴茎延长术或阴茎再造术。     

阴茎延长术治疗先天性隐匿阴茎(附24例报告)

目的探讨阴茎延长术治疗先天性隐匿阴茎的效果。方法于阴茎背侧纵行剪开狭窄环,距冠状沟约0.5 cm环状切开包皮内板,将包皮脱套分离至阴茎根部,完全切除异常附着筋膜并离断部分阴茎悬韧带。分别于3~4点、8~9点处以不吸收线将阴茎白膜与耻骨前皮肤浅筋膜缝合固定。修剪包皮,无张力下缝合包绕冠状沟。结果本组24例均顺利完成手术,术后包皮淋巴水肿3例,3~4周后缓解。1例包皮外形不满意,为早期手术经验不足所致。余20例手术效果良好。随访3个月~1年,所有患儿均未发现阴茎回缩,勃起无侧弯、旋转。结论应用阴茎延长术治疗先天性隐匿阴茎可确切显露阴茎,塑形效果良好,并发症少,手术效果理想。     

聚丙烯酰胺水凝胶注射隆乳术后并发症的分析及防治

目的 探讨聚丙烯酰胺水凝胶注射隆乳术后并发症发生原因及防治方法。提高注射隆乳术的成功率。方法 回顾823例注射聚丙烯酰胺水凝胶隆乳术,分析并发症出现的原因及阐述防治措施。结果 823例中的并发症分别为：单发或多发结节12例。血肿2例,无菌性炎症6例,胸大肌炎4例,凝胶疝出2例。并发症总数为26例。发生率为3.16%。结论 正确的操作方法以及必要的术后护理和按摩。可以有效的防止或减少并发症的发生;一旦出现并发症,及时正确的处理,多数可获得满意的效果。     

聚丙烯酰胺水凝胶注射隆乳术并发症及其处理

目的　总结聚丙烯酰胺水凝胶注射隆乳术后并发症及其防治方法 ,分析其原因 ,最大限度地减少注射隆乳术并发症的发生 ,提高并发症处理的成功率。方法　回顾 1 2 0 0例注射聚丙烯酰胺水凝胶隆乳术 ,分析其并发症出现的原因 ,阐述防治措施。结果　绝大多数患者手术效果满意 ,1 2 0 0例隆乳患者中有 38例出现了可治愈的并发症 (3 .1 7% ) ,其中硬块或硬结 2 1例 (1 .75 % ) ,大小不对称 7例 (0 .58% ) ,血肿 6例 (0 .5 % ) ,红肿痛等炎症反应 4例(0 .33 % ) ,经积极处理后都得到治愈。结论　应严格掌握注射隆乳的适应证和禁忌证 ,严格无菌操作 ,掌握准确的穿刺层次、部位及注射量 ,重视术后处理 ,一旦发生并发症则要及时正确处理     

Corporeal penile plication for correction of erectile penile deformity.

Penile curvature causing functional impairment of sexual intercourse is uncommon but a number of patients are significantly inconvenienced by this condition. Seven patients who had marked erectile deviation were treated with surgical plication for their penile deformity. Mean follow-up was 16 months (range 3-48 months) and no postoperative complications were encountered. In six cases the penis has remained straight. In one patient recurrence of deformity occurred 12 months after corporeal plication. The simplicity of the corporeal plication technique with the low incidence of associated complications makes it an attractive surgical alternative for the treatment of penile erectile deformity.     

CORPOREAL PENILE PLICATION FOR CORRECTION OF ERECTILE PENILE DEFORMITY

Penile curvature causing functional impairment of sexual intercourse is uncommon but a number of patients are significantly inconvenienced by this condition. Seven patients who had marked erectile deviation were treated with surgical plication for their penile deformity. Mean follow-up was 16 months (range 3–48 months) and no postoperative complications were encountered. In six cases the penis has remained straight. In one patient recurrence of deformity occurred 12 months after corporeal plication. The simplicity of the corporeal plication technique with the low incidence of associated complications makes it an attractive surgical alternative for the treatment of penile erectile deformity.     

顺腋纹小切口腋臭根治术并发症的处理和分析

目的：探讨顺腋纹小切口腋臭根治术后并发症出现的原因和处理方法。方法：回顾187例顺腋纹小切口腋臭根治术的病例资料,统计术后发生并发症的情况,分析其出现的原因,阐述防治措施。结果：187例患者中有26例发生术后并发症,其中血肿6例（3.21%）,切缘愈合不良10例（5.35%）,皮肤坏死2例（1.07%）,异味残留8例（4.28%）。结论：顺腋纹小切口腋臭根治术具有创伤小、切口隐蔽、外形美观、无功能障碍的优点,术中操作规范,采取相应的措施可以减少并发症的发生。     

Penile fracture in Kermanshah, Iran: report of 172 cases

PURPOSE: Experience with 172 cases of penile fracture, in Kermanshah, Iran is reviewed. MATERIALS AND METHODS: Records of penile fracture cases were reviewed from April 1990 to October 1999. RESULTS: Diagnosis was made clinically and there was no need to perform cavernosography in any case. The most common mechanism of fracture was referred to by patients as "taghaandan" (to click or snap when forcibly pushing the erect penis down to achieve detumescence). All but 2 cases were treated surgically and 2 cases had concomitant urethral injury diagnosed by selective urethrography. Repair consisted of a circumferential degloving incision to evaluate the corpora. Because of unavailability of synthetic absorbables, inverted knot nylon sutures were used successfully for repair. Delay in operation did not increase difficulty in dissection or early postoperative morbidity. Preoperative and postoperative use of antibiotics was effective in eliminating risk of infection. There were no significant intraoperative or immediate postoperative complications and most patients were discharged home on postoperative day 1. CONCLUSIONS: Patient misinformation about penile tissue properties is the main explanation for the high incidence of penile fracture. Cavernosography, and urethrography and intraoperative urethral catheterization are not routinely needed, as diagnosis can be made clinically. Preoperative and postoperative use of antibiotics, and a uniform surgical plan regardless of delay in presentation are recommended.     

Simple dorsal plication near the 12 o''clock position for the correction of congenital ventral penile curvature

Fourteen patients with congenital penile curvature without hypospadias were treated with a modified Essed dorsal plication method between 1998 and 2002 in our clinic. Patient age ranged between 20 and 25 years (mean 22.2). Eight cases (57.1%) had ventral curvature only and six had an additional lateral curvature. There were no significant postoperative complications. One (7.1%) patient had early suture breakage on the 21st postoperative day during erection and underwent re-operation after 9 months. After a mean follow-up period of 23.2 months (range 3-46) all patients were satisfied with the procedure except for one patient (7.1%) who had a residual curvature of 20 degrees. Four cases (28.6%) had minimal shortening of the penis. The overall satisfaction rate with the procedure was 93%. Simple dorsal plication near the 12 o'clock position is a minimally invasive and effective method for the treatment of congenital ventral penile curvature.     

Medium-term follow-up of plaque incision and porcine small intestinal submucosal grafting for Peyronie's disease

The best surgical option for the management of severe cases of Peyronie's disease is currently a matter of debate. To determine medium-term outcomes and complications after treatment of severe Peyronie's disease by porcine small intestinal submucosa (SIS) grafts, we retrospectively reviewed 33 consecutive plaque incisions followed by 4-ply SIS grafting in 28 patients (2002-2009). Postoperative complications, penile length preservation, de novo ED, penile curvature correction and curvature recurrence rates were recorded. Median patient age was 54 years (38-69 years). Median preoperative curvature was 90° (30-90°) (stable for at least 6 months). Six patients (21%) had preoperative ED. There were few postoperative complications (no cases of infection, haematoma (n=2), penile hypoesthesia (n=1), patch rejection and migration (n=1)). Subjective penile shortening and de novo ED were observed in 7 (25%) and 3 (11%) patients, respectively. The success rate for the procedure (straight penis or curvature ≤20° and ability to have intercourse) was 67% (22/33). Four patients achieved curvature correction after a repeat procedure with a new SIS graft. Eleven patients experienced recurrence within 3 months of surgery. After a median follow-up of 9 months (3-94), 22 patients (79%) had a satisfactory curvature correction.