包皮环切术后微波治疗致阴茎坏死9例报告

发布时间：2018-01-01 00:18

本文关键词：包皮环切术后微波治疗致阴茎坏死9例报告　出处：《中华男科学杂志》2015年05期 　论文类型：期刊论文

【摘要】：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。
[Abstract]:Objective: To investigate the effect of circumcision after microwave treatment induced necrosis of penis mechanism and treatment principle. Methods: from May 2006 to November 2011 to the clinical data of 9 cases of microwave treatment of necrosis of the penis after circumcision. The patients were male, aged 20~39 years (median age 26 years), in other hospitals to prepuce or phimosis accept circumcision, performance at the end of surgery. No penile ischemia after 1 h to 3 D began to implement the application of non-contact microwave treatment. Postoperative 1~10 D appeared necrosis of penis with infection, 4 cases with dressing. Conservative treatment is invalid, postoperative 3~30 D.9 cases in our hospital in 5 cases of dry gangrene in 4 cases,.6 cases of wet gangrene penis necrosis underwent resection of the penis, including 1 cases in 3 months after the surgery penis lengthening surgery; the other 5 cases without.3 cases underwent reoperation for penile necrosis, 1 cases with scrotal skin necrosis; 3 months after total removal of the penis For penile reconstruction, including 2 cases of deep inferior epigastric artery perforator flap (DIEP) and autologous rib twelfth penile implants; 1 cases of groin flap urethroplasty, scrotal skin tube. Results: the patients were followed up for 2~8 years after surgery in this group, can stand micturition, micturition smooth.1 cases in the penis after partial resection of penis residual 3 cm postoperatively from 3 months to accept extended penis, penis length is extended to 7 cm; 5 cases did not receive penis lengthening surgery, penis stump of 3~5 cm, including 4 cases of erectile function, 2 cases of sex life can be.3 underwent penile resection of penis reconstruction, penis shaped the length of (11.7 + 1.3) cm, diameter (11.4 + 2.1) cm, is close to normal penis. Skin feels good recovery, the head of the penis two-point discrimination was 5~12 mm, average 7 mm; DIEP was used in 2 cases of penis reconstruction erection hardness of 3, can meet the life requirements; the other 1 cases penile erectile function 2, Conclusion: after the circumcision, microwave therapy can lead to penile necrosis and serious consequences. We should attach great importance to it. After the occurrence of penis necrosis, debridement should be performed as early as possible, and penile lengthening or penile reconstruction can be performed selectively according to the degree of lesion and the needs of patients.

【作者单位】：浙江大学医学院附属第一医院泌尿外科;
【分类号】：R699.8
【正文快照】： Correspondence to:XIE Li-ping,email:xielp@zjuem.zju.edu.cn;ZHU Xuan-wen,email:zhuxw2004@163.comReceived:September 14,2014;accepted:December 15,2014近年来,我国部分医院在包皮环切术后常规实施微波热疗导致一些患者阴茎坏死,引发了严重医疗纠纷,值得高度重视。2006

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