易性病阴茎再造术中尿道口吻合的改良术式介绍

目的介绍易性病患者(女转男)阴茎再造术中尿道吻合的改良术式,观察其临床效果。方法回顾性分析2016年12月至2020年12月海军军医大学第二附属医院行阴茎和尿道再造手术的易性病(女转男)病例资料。在以阴道黏膜预置的下腹部皮瓣或股前外侧皮瓣行阴茎和尿道再造的手术中,将二期法改为三期法,即二期手术时在预置尿道口的近会阴端预留2 cm宽的皮瓣桥,将预制尿道口与阴阜处预留的尿道口通过皮瓣桥缝合,即两个尿道口之间以此2 cm皮瓣隔开而不做吻合,6个月后再行三期尿道吻接手术。对患者阴茎再造术后尿道功能进行随访,主要观察是否有尿瘘、能否站立排尿,以及尿道通畅情况。结果共纳入6例易性病(女转男)患者,年龄29~40岁,手术过程顺利,其中4例采用右侧股前外侧皮瓣再造阴茎,2例采用左下腹部皮瓣。6例中有1例患者术后1周阴茎远端皮瓣有少部分坏死,游离植皮术后愈合。术后随访10~30个月,所有患者均未发生尿瘘,都能站立排尿,尿道未发生狭窄、完全通畅。结论下腹部皮瓣或股前外侧皮瓣预置尿道、阴茎再造术中,三期改良尿道吻合的技术可以降低易性病(女转男)患者术后尿瘘和尿道狭窄的发生率。

A modified method of urethral anastomosis of phalloplasty in female-to-male transsexuals

Objective To explore the clinical effect of modified urethral anastomosis in penile reconstruction for female-to-male(FTM)transsexuals.Methods A retrospective analysis was performed on the FTM transsexuals undergoing penile and urethral reconstruction in Second Affiliated Hospital of Naval Medical University from December 2016 to December 2020.In this method,lower abdominal flap and anterolateral thigh(ALT)flap were used to reconstruct the neophallus,and vaginal mucosa was used to reconstruct the urethra step by step.The 2 stage procedure was divided into 3 stage.During the second stage operation,a 2 cm wide flap bridge was reserved near the perineal end of the prefabricated urethral opening,which separated the prefabricated urethral from the urethra reserved at the pubic area.And the third stage urethral anastomosis was performed 6 months later.The urethral function after penile reconstruction was followed up to observe whether the patients had urinary fistula,standing urination and urethral patency.Results A total of 6 FTM transsexuals,aged 29-40 years,were enrolled in the study.The operation was successful.Among them,the right ALT flap was used in 4 cases,and the left lower abdominal flap was used in 2 cases.In one case,partial flap necrosis was found in the distal part of the penis one week after the second stage surgery,which healed with free skin grafting after 2 weeks.During postoperative follow-up of 10-30 months,no urinary fistula occurred and all patients were able to urinate standing up,with no urethral stricture.Conclusions The urethra was prefabricated with a lower abdominal flap or ALT flap,and then the procedure of phalloplasty and modified urethral anastomosis was performed in stages,which could reduce the incidence of urinary fistula and urethral stricture in FTM transsexuals.