应用脱细胞异体真皮补片行阴茎增粗术的并发症及处理
|
摘要
目的:探讨应用脱细胞异体真皮补片行阴茎增粗术的术后并发症及其相关处理。方法:回顾性分析2016年6月至2019年1月于北京大学人民医院及外院会诊收治的78例应用脱细胞异体真皮补片行阴茎增粗术患者的临床资料,对术后并发症进行总结并提出相应解决方案。结果:本组78名患者平均年龄31.14岁(21～66岁),均应用脱细胞异体真皮补片行阴茎增粗术,随访时间3～34个月,术后3个月随访时周长平均增加1.1 cm(0.5～2.1cm),平均随访时间12.20个月。术后并发症包括:勃起不适感47例、伤口愈合不良12例、增粗效果不明显10例、补片邮票样改变9例、伤口周围血肿8例、包皮水肿7例、伤口感染4例、背侧皮肤坏死3例、心理影响2例,予以相应治疗后最终7名患者行补片取出术。结论:规范的手术方法、严谨的术后护理以及对患者的充分告知可以有效减少应用脱细胞异体真皮补片行阴茎增粗术的并发症,对并发症进行及时且正确的处理可以获得满意的效果。
Objective:To investigate and analyze the complications of penile augmentation with acellular dermal matrix(ADM) and following management.Methods:This was a retrospective review of all patients who received penile augmentation with ADM between June 2016 and January 2019.The patients were evaluated with outpatient physical examination.Related complications and following management were summarized and analyzed.Results:Between June 2016 and January 2019,ADM was used as filling material on 78 patients(mean age:31.14 years,range:21-66 years),who were successfully received penile augmentation surgery.In the follow-up three months,the penile circumference was increased by1.1 cm(0.5-2.1 cm) on average.The mean follow-up time was 12.20 months.In this study,there were 47(60.26%,47/78) patients with erectile discomfort,91.49%(43/47) of whom manifested as erectile traction.There were 12(15.38%,12/78) patients with delayed healing,improved by daily regular dressing change.There were 10(12.82%,10/78) patients with unobvious augmentation effect.There were 9(11.54%,9/78) patients with stamp-like changes of ADM.There were 8(10.26%,8/78) patients with wound hematoma and 7(8.97%,7/78) patients with foreskin edema,relieved by compression with wrap.There were 4(5.13%,4/78) patients with wound infection and 3(3.85%,3/78) patients with skin necrosis of the dorsal side,which could be treated with ADM removal and repair surgery with bipedicle scrotal flap.And there were 2(2.56%,2/78) patients suffering psychological influence.Finally,most patients with various complications recovered successfully,however 7 patients(8.97%,7/78) underwent ADM removal surgery.Conclusion:Using ADM as filling material could achieve positive effect in penile augmentation but the complications are common and cannot be neglected.Standardized surgical methods,rigorous postoperative care,and adequate notification with patients can effectively reduce the complications of penile augmentation with ADM.To treat properly and timely for complications can obtain satisfactory results.
Objective:To investigate and analyze the complications of penile augmentation with acellular dermal matrix(ADM) and following management.Methods:This was a retrospective review of all patients who received penile augmentation with ADM between June 2016 and January 2019.The patients were evaluated with outpatient physical examination.Related complications and following management were summarized and analyzed.Results:Between June 2016 and January 2019,ADM was used as filling material on 78 patients(mean age:31.14 years,range:21-66 years),who were successfully received penile augmentation surgery.In the follow-up three months,the penile circumference was increased by1.1 cm(0.5-2.1 cm) on average.The mean follow-up time was 12.20 months.In this study,there were 47(60.26%,47/78) patients with erectile discomfort,91.49%(43/47) of whom manifested as erectile traction.There were 12(15.38%,12/78) patients with delayed healing,improved by daily regular dressing change.There were 10(12.82%,10/78) patients with unobvious augmentation effect.There were 9(11.54%,9/78) patients with stamp-like changes of ADM.There were 8(10.26%,8/78) patients with wound hematoma and 7(8.97%,7/78) patients with foreskin edema,relieved by compression with wrap.There were 4(5.13%,4/78) patients with wound infection and 3(3.85%,3/78) patients with skin necrosis of the dorsal side,which could be treated with ADM removal and repair surgery with bipedicle scrotal flap.And there were 2(2.56%,2/78) patients suffering psychological influence.Finally,most patients with various complications recovered successfully,however 7 patients(8.97%,7/78) underwent ADM removal surgery.Conclusion:Using ADM as filling material could achieve positive effect in penile augmentation but the complications are common and cannot be neglected.Standardized surgical methods,rigorous postoperative care,and adequate notification with patients can effectively reduce the complications of penile augmentation with ADM.To treat properly and timely for complications can obtain satisfactory results.
引文
[1]Evangelos S,Charalambos C,Dimitrios B,et al.Augmentation phalloplasty surgery for penile dysmorphophobia in young adults:considerations regarding patient selection,outcome evaluation and techniques applied[J].Eur Urol,2005,48(1):121-128.
[2]麦凯欣,朱辉.阴茎增粗术的研究进展[J].中国美容整形外科杂志,2009,20(9):558-561.
[3]Whitehead E.Allograft dermal matrix graft(Alloderm)for pericavernosal penile widening in normal men[C].Abstract presented at:First World Congress on Aesthetic Medicine,2004.
[4]杨文博,张晓威,兰轲.脱细胞异体真皮补片联合阴茎增粗术对早泄的作用与安全性[J].中国性科学,2018,27(7):18-20.
[5]Zhang X,Wu Y,Zhang M,et al.Acellular dermal matrix in premature ejaculation:A preliminary study[J].Medicine,2018,97(45):e13135.
[6]Livesey SA,Herndon DN,Hollyoak MA,et al.Transplanted acellular allograft dermal matrix.Potential as a template for the reconstruction of viable dermis[J].Transplantation,1995,60(1):1-9.
[7]Chen RN,Ho HO,Tsai YT,et al.Process development of an acellular dermal matrix(ADM)for biomedical applications[J].Biomaterials,2004,25(13):2679-2686.
[8]陈一宁,但卫华,但年华.脱细胞真皮基质的改性及应用概述[J].材料导报,2018,32(13):2311-2319.
[9]林健,郝金瑞,金杰,等.人同种异体真皮脱细胞基质在尿道重建中的临床应用[J].中华医学杂志,2005,85(15):1057-1059.
[10]符津山,周治彦,许思怡.骨髓间充质干细胞联合脱细胞真皮基质修复尿道损伤[J].中国组织工程研究,2018,22(13):2075-2080.
[11]殷鹏程,黄万顺,姚明文,等.4种阴茎增粗术治疗阴茎细小158例疗效分析[J].浙江医学,2016,38(23):1948-1949.
[12]吴小蔚,简麒超,董玉林,等.阴茎延长同期行脱细胞异体真皮基质补片双平面植入阴茎增粗术[J].中华医学美学美容杂志,2011,17(5):336-339.
[13]Tealab AA,Maarouf AM,Habous M,et al.The use of an acellular collagen matrix in penile augmentation:A pilot study in Saudi Arabia[J].Arab Journal of Urology,2013,11(2):169-173.
[14]Jung GW.Penile girth enhancement with allograft,penile augmentation[M].Germany:Springer,2016:83-92.
[15]Alter G,Jordan G.Penile elongation and girth enhancement[J].AUA Update Series,2007,26:229-237.
[16]Bruno JJ 2nd,Senderoff DM,Fracchia JA,et al.Reconstruction of penile wounds following complications of Allo Derm-based augmentation phalloplasty[J].Plast Reconstr Surg,2007,119(1):1e-4e.
[17]李战松.脱细胞异体真皮基质医用组织补片在阴茎增粗成形中的应用[J].中国性科学,2013,22(10):59-61.
[18]Chu CH,Shieh SJ.Reconstruction of circumferential skin defect of the penile shaft using a bipedicle scrotal flap[J].Dermatol Surg,2012,38(2):266-270.
[19]陶谏,任永安,柏龙文.阴囊双蒂袋状皮瓣套入法一期修复阴茎皮肤缺损一例[J].中华整形外科杂志,2001,17(3):143.
[20]王祥,刘德贵,石敏,等.阴囊双蒂皮瓣修复包皮环切术后包皮过短[J].中华泌尿外科杂志,1994(6):448.
[21]陈媛媛,陆鑫锋,赵亮,等.阴囊双蒂皮瓣联合皮片移植治疗男性外阴大面积乳房外Paget病[J].中华皮肤科杂志,2012,45(12):904-905.
[22]Weber DM,Landolt MA,Gobet R,et al.The penile perception score:an instrument enabling evaluation by surgeons and patient self-assessment after hypospadias repair[J].J Urol,2013,189(1):189-193.
[2]麦凯欣,朱辉.阴茎增粗术的研究进展[J].中国美容整形外科杂志,2009,20(9):558-561.
[3]Whitehead E.Allograft dermal matrix graft(Alloderm)for pericavernosal penile widening in normal men[C].Abstract presented at:First World Congress on Aesthetic Medicine,2004.
[4]杨文博,张晓威,兰轲.脱细胞异体真皮补片联合阴茎增粗术对早泄的作用与安全性[J].中国性科学,2018,27(7):18-20.
[5]Zhang X,Wu Y,Zhang M,et al.Acellular dermal matrix in premature ejaculation:A preliminary study[J].Medicine,2018,97(45):e13135.
[6]Livesey SA,Herndon DN,Hollyoak MA,et al.Transplanted acellular allograft dermal matrix.Potential as a template for the reconstruction of viable dermis[J].Transplantation,1995,60(1):1-9.
[7]Chen RN,Ho HO,Tsai YT,et al.Process development of an acellular dermal matrix(ADM)for biomedical applications[J].Biomaterials,2004,25(13):2679-2686.
[8]陈一宁,但卫华,但年华.脱细胞真皮基质的改性及应用概述[J].材料导报,2018,32(13):2311-2319.
[9]林健,郝金瑞,金杰,等.人同种异体真皮脱细胞基质在尿道重建中的临床应用[J].中华医学杂志,2005,85(15):1057-1059.
[10]符津山,周治彦,许思怡.骨髓间充质干细胞联合脱细胞真皮基质修复尿道损伤[J].中国组织工程研究,2018,22(13):2075-2080.
[11]殷鹏程,黄万顺,姚明文,等.4种阴茎增粗术治疗阴茎细小158例疗效分析[J].浙江医学,2016,38(23):1948-1949.
[12]吴小蔚,简麒超,董玉林,等.阴茎延长同期行脱细胞异体真皮基质补片双平面植入阴茎增粗术[J].中华医学美学美容杂志,2011,17(5):336-339.
[13]Tealab AA,Maarouf AM,Habous M,et al.The use of an acellular collagen matrix in penile augmentation:A pilot study in Saudi Arabia[J].Arab Journal of Urology,2013,11(2):169-173.
[14]Jung GW.Penile girth enhancement with allograft,penile augmentation[M].Germany:Springer,2016:83-92.
[15]Alter G,Jordan G.Penile elongation and girth enhancement[J].AUA Update Series,2007,26:229-237.
[16]Bruno JJ 2nd,Senderoff DM,Fracchia JA,et al.Reconstruction of penile wounds following complications of Allo Derm-based augmentation phalloplasty[J].Plast Reconstr Surg,2007,119(1):1e-4e.
[17]李战松.脱细胞异体真皮基质医用组织补片在阴茎增粗成形中的应用[J].中国性科学,2013,22(10):59-61.
[18]Chu CH,Shieh SJ.Reconstruction of circumferential skin defect of the penile shaft using a bipedicle scrotal flap[J].Dermatol Surg,2012,38(2):266-270.
[19]陶谏,任永安,柏龙文.阴囊双蒂袋状皮瓣套入法一期修复阴茎皮肤缺损一例[J].中华整形外科杂志,2001,17(3):143.
[20]王祥,刘德贵,石敏,等.阴囊双蒂皮瓣修复包皮环切术后包皮过短[J].中华泌尿外科杂志,1994(6):448.
[21]陈媛媛,陆鑫锋,赵亮,等.阴囊双蒂皮瓣联合皮片移植治疗男性外阴大面积乳房外Paget病[J].中华皮肤科杂志,2012,45(12):904-905.
[22]Weber DM,Landolt MA,Gobet R,et al.The penile perception score:an instrument enabling evaluation by surgeons and patient self-assessment after hypospadias repair[J].J Urol,2013,189(1):189-193.