阴茎大部分缺损功能性修复术的研究

目的:探讨阴茎大部分缺损的有效修复方法.方法:通过尸体解剖,了解阴茎悬韧带的厚度、阴茎脚剥离长度与稳定性的关系.通过超声影像了解正常人阴茎根部血管走向以及阴茎深动脉进入海绵体的长度.对40例阴茎短小病例行扩大的阴茎海绵体延伸术、龟头和冠状沟塑形术.修复术中通过离断阴茎浅、深悬韧带,并继续分离部分海绵体脚,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;选用合适的带血管蒂皮瓣转移覆盖海绵体,塑造更为逼真的龟头和冠状沟样外形.阴茎修复术后取材移植皮瓣全层皮肤,分别进行光镜、免疫组化、透射电镜和扫描电镜检测,观察皮肤神经再生情况;通过感觉功能的检测了解阴茎感觉功能恢复情况;采用夜间阴茎勃起测定系统检测修复阴茎勃起功能.结果:经30例60侧尸体解剖发现,阴茎浅悬韧带前缘至阴茎深悬韧带后缘平均7.66 cm.放射影像学造影显示阴茎海绵体在耻骨联合下份分开,两侧海绵体脚分别附着于耻骨下支,末端达耻骨下支中份.超声影像学检测14例正常健康男性,显示阴茎根部至阴茎深动脉进入海绵体处的长度平均6.6 cm.临床修复阴茎40例,术前残留阴茎常态下长度0.5～4.0 cm,勃起时长度2.0～6.0 cm;术后常态下长度5.0～8.5 cm,勃起时长度增至7.0～12.5 cm.随访1年以上28例,已婚23例,性生活基本满意,已育18例.移植部位的皮肤经光镜、免疫组化标记、透射电镜和扫描电镜检测,均可见再生的神经纤维束及相关组织.阴茎感觉功能基本恢复.勃起功能测定与正常人相同.结论:对阴茎局部解剖学调查、放射和超声影像学检测、修复阴茎皮肤感觉和勃起功能的检测结果,弥补了阴茎修复术实验研究的不足,为继续开展阴茎修复术及相关研究提供了有价值的资料.用本法修复之阴茎不但在长度和形态上已接近正常,且具备良好的感觉与勃起功能,可部分替代传统的阴茎修复术,是修复阴茎不完全缺损较为理想的方法.

Experimental and clinical study on functional restoration of the penis with large partial defect

OBJECTIVE: To investigate the effective restoration method in penile partial defect. METHODS: To measure the thickness of suspensory ligaments on cadavers; To find the relationship between inferior pubic ramus and corpora cavernosa crus through corpora cavernosa angiography and ultrasonic scanning. The procedure of restoration was based on the use of dissection of the suspensory ligaments and part of crus, and the local fat flap had been transferred to fill the front space of symphysis ossium pubi. Various flaps were designed as coverage material. Penis residual stump was advanced to anterior portion of the newly restoration penile body as "glans"; To take full layer skin of penis from post-operating patients to observe neurofibril regeneration by light microscopy, electron microscopy and scanning electron microscopy; To determine sensation recovery by physical examination; To check erectile function with NEVA System. RESULTS: The whole suspensory ligaments thickness was 7.66 cm in average on 30 cadavers (60 sides). The crus were attached to bilateral inferior pubic ramus respectively, and distal reached the middle of inferior pubic ramus by corpora cavernosa angiography. In 14 health men by ultrasonic scanning, 6.60 cm in average from root of external penis to location of deep artery penis entered corpora cavernosa. Forty patients had been operated with the above methods. In the cases, the length of the penis varied from 0.5-4.0 cm in the flaccid, 2.0-6.0 cm in erect state before operation to 5.0-8.5 cm in the flaccid, 7.0-12.5 cm in erect state after operation. Twenty-eight cases had been followed up for more than one year, and 23 patients married with acceptable sexual life, eighteen men had successfully produced their next generations. The regenerative neurofibril could be seen under light microscope, immunohistochemistry marker, scanning and transmission electron microscope. The penis presented normal pain and touch feeling in the post-operating cases. The results showed that there was similar erectile ability of a normal male in the follow-up patients. CONCLUSION: With these basic and clinical researches, the restoration of penis tends to have a better appearance and function. It's a more optimal method compared with conventional procedures. The results have also provided valuable data for further study in related fields.