再造阴茎感觉功能重建的电生理研究
摘要
本研究旨在探讨再造阴茎感觉功能重建的有效方法及机制。实验以家兔为研究对象,首先运用电生理方法明确家兔阴茎皮肤感觉神经躯体纤维来源的分布规律,以此为基础,建立游离隐神经移植与阴茎背神经吻接后植入腹壁浅血管蒂皮瓣再造阴茎的动物模型,通过神经单纤维放电及神经源性血浆外渗方法,对再造阴茎感觉功能恢复情况进行观察。结果证实:①家兔阴茎皮肤感觉神经躯体纤维主要来源于S2-S3脊神经。②游离隐神经移植与阴茎背神经端端吻合植入以腹壁浅血管蒂皮瓣再造的阴茎,可以获得良好的感觉神经再生,感受器重新获得神经再支配,植入神经能够恢复再造阴茎的感觉功能。该研究结果为临床上重建再造阴茎的感觉功能提供了实验基础和理论依据。
The purpose of this study was to investigate the possibility and mechanism of sensory restoration of the reconstructed penis and to explore a new surgical technique to improve the postoperative sensory function in phallic reconstruction. Firstly, Electrophysiological method was used to definitude the segmental distribution of the origin of the somatic fibers in the phallic sensory nerves of rabbits. Sensory nerve implantation was applied to establish the animal model of sensory restoration in phallic reconstruction, in which one lateral saphenous nerve graft was dissected as the donor nerve and anastomosed to one lateral dorsal nerve of the rabbit’s penis by end-to-end, and subsequently embedded in a superficial epigastric faciovascular pedicle flap for phalloplasty. Then the process of sensory recovery and nerve regeneration was evaluated by single nerve fiber recording and neugenic plasma extravasation method. Results showed that: 1) The rabbit’s sensory nerve fibers of the penis are origined from S2,S3 spinal nerves. 2) The new technique of phalloplasty established in this study can regenerate functional nerve and recover the sensory function of the reconstructed penis to a certain extent. These findings can provide theoretic and experimental basis for its clinical application to fulfill the sensory restoration of the reconstructed penis.
The purpose of this study was to investigate the possibility and mechanism of sensory restoration of the reconstructed penis and to explore a new surgical technique to improve the postoperative sensory function in phallic reconstruction. Firstly, Electrophysiological method was used to definitude the segmental distribution of the origin of the somatic fibers in the phallic sensory nerves of rabbits. Sensory nerve implantation was applied to establish the animal model of sensory restoration in phallic reconstruction, in which one lateral saphenous nerve graft was dissected as the donor nerve and anastomosed to one lateral dorsal nerve of the rabbit’s penis by end-to-end, and subsequently embedded in a superficial epigastric faciovascular pedicle flap for phalloplasty. Then the process of sensory recovery and nerve regeneration was evaluated by single nerve fiber recording and neugenic plasma extravasation method. Results showed that: 1) The rabbit’s sensory nerve fibers of the penis are origined from S2,S3 spinal nerves. 2) The new technique of phalloplasty established in this study can regenerate functional nerve and recover the sensory function of the reconstructed penis to a certain extent. These findings can provide theoretic and experimental basis for its clinical application to fulfill the sensory restoration of the reconstructed penis.
引文
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2. Sadove RC, Sengezer M, McRoberts JW, et al. One-stage total penile reconstruction with a free sensate osteocutaneous fibula flap. Plast Reconstr Surg, 1993, 92: 1314-1323.
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5. Sievert KD. Vaginal and penile reconstruction. Curr Opin Urol, 2003, 13: 489-494.
6. Perovic SV, Djordjevic ML, Kekic ZK, et al. Penile surgery and reconstruction. Curr Opin Urol, 2002, 12: 191-194.
7. Hage JJ. Conception following penile reconstruction. Plast Reconstr Surg, 2000, 105: 2632-2633.
8. Bettocchi C,Ralph DJ,Pryor JP. Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int, 2005, 95: 120-124.
9. Santanelli F,Paolini G. Glans, urethra, and corporeal body reconstruction by free osteocutaneous forearm flap transfer. Ann Plast Surg, 2003, 50: 545-549.
10. Perovic SV,Djordjevic ML. Metoidioplasty: a variant of phalloplasty in female transsexuals. BJU Int, 2003, 92: 981-985.
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4. Gilbert DA, Horton CE, Terzis JK, et al. New concepts in phallic reconstruction. Ann Plast Surg, 1987, 18: 128-136.
5. Hage JJ,Bloem JJ,Suliman HM. Review of the literature on techniques for phalloplasty with emphasis on the applicability in female-to-male transsexuals. J Urol, 1993, 150: 1093-1098.
6. Hage JJ. Conception following penile reconstruction. Plast Reconstr Surg, 2000, 105: 2632-2633.
7. Perovic SV, Djordjevic ML, Kekic ZK, et al. Penile surgery and reconstruction. Curr Opin Urol, 2002, 12: 191-194.
8. Sievert KD. Vaginal and penile reconstruction. Curr Opin Urol, 2003, 13: 489-494.
9. Bettocchi C,Ralph DJ,Pryor JP. Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int, 2005, 95: 120-124.
10. Hu ZQ, Hyakusoku H, Gao JH, et al. Penis reconstruction using three different operative methods. Br J Plast Surg, 2005, 58: 487-492.
11. Ralph DJ,Garaffa G,Garcia MA. Reconstructive surgery of the penis. CurrOpin Urol, 2006, 16: 396-400.
12. 宋儒耀. 阴茎癌切除术后的即时阴茎再造术. 新医学, 1978, 1: 53.
13. 何清濂. 腹壁双血管蒂筋膜皮肤瓣一次完成阴茎再造(附 12 例报告). 中华外科杂志, 1986, 24: 216-218.
14. 孙广慈. 应用髂嵴腹股沟外侧复合皮瓣一次完成阴茎再造. 中国医学科学院学报, 1984, 6: 439-442.
15. Ak?z T, Erdogan B, G?rgü M, et al. Penile reconstruction in children using a double vascular pedicle composite groin flap. Scand J Urol Nephrol, 1998, 32: 225-230.
16. 龙道畴. 带双血管蒂的髂骨嵴复合岛状皮瓣一期再造阴茎. 中华外科杂志, 1988, 12: 747-749.
17. 于立新, 刘小友, 付绍杰, 等. 应用髂腹股沟-脐胸复合皮瓣一期 8 例术后
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19. 吴建明, 林子豪, 杨松林, 等. 双渠道血供腹壁皮瓣阴茎再造术. 中华整形外科杂志, 2001, 6: 344-346.
20. Perovic S. Phalloplasty in children and adolescents using the extended pedicle island groin flap. J Urol, 1995, 154: 848-853.
21. Koshima I, Nanba Y, Nagai A, et al. Penile reconstruction with bilateral superficial circumflex iliac artery perforator (SCIP) flaps. J Reconstr Microsurg, 2006, 22: 137-142.
22. 何清濂, 章惠兰, 陈敏亮, 等. 阴股沟皮瓣一期器官(阴道、阴茎)再造. 第二军医大学学报, 1990, 1: 24.
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8. Schafers M,Cain D. Single-fiber recording: in vivo and in vitro preparations. Methods Mol Med, 2004, 99: 155-166.
9. 张琪, 赵晏, 田雨灵, 等. 局部注射 αβme-ATP 对大鼠背部皮肤初级传人纤维的兴奋作用. 第一军医大学学报, 2005, 25: 1256-1260.
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16. Kagitani F, Uchida S, Hotta H, et al. Manual Acupuncture Needle Stimulation of the Rat Hindlimb Activates Groups I, II, III and IV Single Afferent Nerve Fibers in the Dorsal Spinal Roots. Jpn J Physiol, 2005, 55: 149-155.
17. Suzuki Y, Sato J, Kawanishi M, et al. Lowered response threshold and increased responsiveness to mechanical stimulation of cutaneous nociceptive fibers in streptozotocin-diabetic rat skin in vitro--correlates of mechanical allodynia and hyperalgesia observed in the early stage of diabetes. Neurosci Res, 2002, 43: 171-178.
18. Shim B, Kim DW, Kim BH, et al. Mechanical and heat sensitization of cutaneous nociceptors in rats with experimental peripheral neuropathy. Neuroscience, 2005, 132: 193-201.
19. Vleggeert-Lankamp CL, van den Berg RJ, Feirabend HK, et al. Electrophysiology and morphometry of the Aalpha- and Abeta-fiber populations in the normal and regenerating rat sciatic nerve. Exp Neurol, 2004, 187: 337-349.
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