精细解剖性显微再植术治疗4例阴茎完全离断伤

王议鹤; 王鹏; 罗勇; 张勇; 童大力; 毕罡; 金大春; 周婉怡; 冯庆兴; 刘高磊; 黄义强; 李彦锋

doi:10.16016/j.2097-0927.202212082

您当前的位置：

首页 >

文章列表页 >

精细解剖性显微再植术治疗4例阴茎完全离断伤

临床医学 | 更新时间：2026-01-09

- 精细解剖性显微再植术治疗4例阴茎完全离断伤
- Meticulous anatomic microreplantation for complete penile amputation: a report of 4 cases
- 陆军军医大学学报 2023年45卷第13期页码：1430-1435
- 作者机构：
  
  400042 重庆，陆军特色医学中心泌尿外科
- 作者简介：
  
  [李彦锋，E-mail：1738401063@qq.comLI Yanfeng, E-mail: 1738401063@qq.com
- 基金信息：
- DOI：10.16016/j.2097-0927.202212082
  中图分类号： R616.2;R697.15;R699.8
- 收稿：2022-12-12，
  
  修回：2023-01-06，
  
  纸质出版：2023-07-15
- 稿件说明：
移动端阅览
王议鹤, 王鹏, 罗勇, 等. 精细解剖性显微再植术治疗4例阴茎完全离断伤[J]. 陆军军医大学学报, 2023,45(13):1430-1435.

Yihe WANG, Peng WANG, Yong LUO, et al. Meticulous anatomic microreplantation for complete penile amputation: a report of 4 cases[J]. Journal of Army Medical University, 2023, 45(13): 1430-1435.
王议鹤, 王鹏, 罗勇, 等. 精细解剖性显微再植术治疗4例阴茎完全离断伤[J]. 陆军军医大学学报, 2023,45(13):1430-1435. DOI： 10.16016/j.2097-0927.202212082.

Yihe WANG, Peng WANG, Yong LUO, et al. Meticulous anatomic microreplantation for complete penile amputation: a report of 4 cases[J]. Journal of Army Medical University, 2023, 45(13): 1430-1435. DOI： 10.16016/j.2097-0927.202212082.

摘要

目的

分析和总结我院4例阴茎完全离断伤行精细解剖性显微再植术患者的治疗经验，提高阴茎离断伤的早期处置水平，改善预后。

方法

收集本院泌尿外科自2018年3月至2022年10月收治的阴茎完全离断伤患者的临床资料，对其相关临床特征、显微手术过程、术后处理及随访结局进行回顾性分析。

结果

4例患者均顺利实施精细解剖性显微再植术。2例成功进行两侧阴茎背动脉吻合，2例仅行一侧阴茎背动脉吻合；患者均完成阴茎背深静脉的吻合；3例患者完成背浅静脉吻合；所有患者完成阴茎背部两侧4~6背神经吻合。手术时间6.5~7.5 h，平均6.9 h；热缺血时间1~4 h，平均1.9 h。随访结果显示：3例阴茎再植成功，但其中2例出现部分包皮坏死，于2~3个月后自行愈合。该3例患者术后排尿正常，术后3~6个月检测勃起功能显示患者勃起硬度评分达到3~4分，自述恢复满意。

结论

阴茎完全离断伤后离体阴茎热缺血时间短者，尽快行精细显微阴茎再植术可获得理想的阴茎外观和功能恢复。

Abstract

Objective

To improve the early management of penile amputation injury by analyzing and summarizing our microreplantation experience of 4 cases of complete penile amputation.

Methods

Clinical data of 4 patients with complete penile amputation admitted to our hospital from March 2018 to October 2022 were collected

and their related clinical features

microsurgical procedures

post-operative treatment and follow-up outcomes were retrospectively analyzed.

Results

Meticulous anatomical microreplantation was successfully performed on all the 4 patients. Two of them received successfully bilateral penile dorsal arteries anastomosis

and the other two got only one dorsal artery anastomosis. All patients completed anastomosis of deep dorsal penile vein

and 3 of them had superficial dorsal vein anastomosis. Anastomosis of 4~6 dorsal nerves on both sides of the back of the penis were completed in all the patients. The operation time ranged from 6.5 to 7.5 h

with an average of 6.9 h. The warm ischemia period was 1~4 h

averagely 1.9 h. During the follow-up

3 cases obtained successful penis replantation

although 2 of them had partial necrosis of foreskin

which healed naturally after 2~3 months. These 3 patients had normal urinations after operation

and had an erectile hardness score of 3~4 in 3~6 months after operation

with satisfactory self-reported recoveries.

Conclusion

For the patients with short warm ischemia period after complete penile amputation

microreplantation should be carried out as soon as possible in order to obtain satisfactory appearance and functional recovery of the penis.

关键词

Keywords

references

MORRISON S D, SHAKIR A, VYAS K S, et al . Penile replantation: a retrospective analysis of outcomes and complications[J ] . J Reconstr Microsurg, 2017, 33(4): 227-232. DOI: 10.1055/s-0036-1597567.

李贵忠, 满立波, 何峰, 等. 国人阴茎离断再植Meta分析[J]. 中华男科学杂志, 2013, 19(8): 722-726.

LI G Z, MAN L B, HE F, et al . Replantation of amputated penis in Chinese men: a meta-analysis[J ] . Natl J Androl, 2013, 19(8): 722-726.

LIU X D, LI Y F, WANG Q, et al . Microscopic replantation of completely amputated penis and testes: a case report and literature review[J ] . Int Urol Nephrol, 2020, 52(7): 1271-1277. DOI: 10.1007/s11255-020-02407-z.

PHONSOMBAT S, MASTER V A, MCANINCH J W. Penetrating external genital trauma: a 30-year single institution experience[J]. J Urol, 2008, 180(1): 192-195;discussion 195-196. DOI: 10.1016/j.juro.2008.03.041.

FULLER A, BOLT J, CARNEY B. Successful microsurgical penile replantation after a workplace injury[J]. Urol Int, 2007, 78(1): 10-12. DOI: 10.1159/000096928.

YAMANO Y, TANAKA H. Replantation of a completely amputated penis by the microsurgical technique: a case report[J]. Microsurgery, 1984, 5(1): 40-43. DOI: 10.1002/micr.1920050109.

RIYACH O, EL MAJDOUB A, TAZI M F, et al . Successful replantation of an amputated penis: a case report and review of the literature[J ] . J Med Case Rep, 2014, 8: 125. DOI: 10.1186/1752-1947-8-125.

GYAN S, SUSHMA S, MANEESH S, et al . Successful microsurgical penile replantation following self amputation in a schizophrenic patient[J ] . Indian J Urol, 2010, 26(3): 434-437. DOI: 10.4103/0970-1591.70589.

FUJIKI M, OZAKI M, KAI A, et al . Successful second microsurgical replantation for amputated penis[J ] . Plast Reconstr Surg Glob Open, 2017, 5(9): e1512. DOI: 10.1097/GOX.0000000000001512.

OZTURK A, KILINC M, GUVEN S, et al . Penis replantation after self-mutilation[J ] . Int Urol Nephrol, 2009, 41(1): 109-111. DOI: 10.1007/s11255-008-9374-3.

YENIYOL C O, YENER H, KEÇECI Y, et al . Microvascular replantation of a self amputated penis[J ] . Int Urol Nephrol, 2002, 33(1): 117-119. DOI: 10.1023/a: 1014437927083.

EHRICH W S. Two unusual penile injuries[J]. J Urol, 1929, 21(2): 239-241. DOI: 10.1016/s0022-5347(17)73098-4.

MENDEZ R, KIELY W F, MORROW J W. Self-emasculation[J]. J Urol, 1972, 107(6): 981-985. DOI: 10.1016/s0022-5347(17)61188-1.PMID: 834785.

BHANGANADA K, CHAYAVATANA T, PONGNUMKUL C, et al . Surgical management of an epidemic of penile amputations in Siam[J ] . Am J Surg, 1983, 146(3): 376-382. DOI: 10.1016/0002-9610(83)90420-8.

COHEN B E, MAY J W JR, DALY J S, et al . Successful clinical replantation of an amputated penis by microneurovascular repair. Case report[J ] . Plast Reconstr Surg, 1977, 59(2): 276-280.

SHUKLA C J, BROWN G, DORKIN T, et al . British Association of Urological Surgeons (BAUS) consensus document for the management of male genital emergencies—penile amputation[J ] . BJU Int, 2018, 121(5): 699-702. DOI: 10.1111/bju.14135.

BABAEI A R, SAFARINEJAD M R. Penile replantation, science or myth? A systematic review[J]. Urol J, 2007, 4(2): 62-65.

LANDSTRÖM J T, SCHUYLER R W, MACRIS G P. Microsurgical penile replantation facilitated by postoperative HBO treatment[J]. Microsurgery, 2004, 24(1): 49-55. DOI: 10.1002/micr.10192.

CHOU E K, TAI Y T, WU C I, et al . Penile replantation, complication management, and technique refinement[J ] . Microsurgery, 2008, 28(3): 153-156. DOI: 10.1002/micr.20470.

DAREWICZ B, GALEK L, DAREWICZ J, et al . Successful microsurgical replantation of an amputated penis[J ] . Int Urol Nephrol, 2001, 33(2): 385-386. DOI: 10.1023/a: 1015226115774.

VIRASORO R, TONKIN J B, MCCAMMON K A, et al . Penile amputation: cosmetic and functional results[J ] . Sex Med Rev, 2015, 3(3): 214-222. DOI: 10.1002/smrj.50.

BANIHANI O I, FOX J A, GANDER B H, et al . Complete penile amputation during ritual neonatal circumcision and successful replantation using postoperative leech therapy[J ] . Urology, 2014, 84(2): 472-474. DOI: 10.1016/j.urology.2014.04.021.

VAN DER MERWE A, GRAEWE F, ZVHLKE A, et al . Penile allotransplantation for penis amputation following ritual circumcision: a case report with 24 months of follow-up[J ] . Lancet, 2017, 390(10099): 1038-1047. DOI: 10.1016/S0140-6736(17)31807-X.

JEZIOR J R, BRADY J D, SCHLOSSBERG S M. Management of penile amputation injuries[J]. World J Surg, 2001, 25(12): 1602-1609. DOI: 10.1007/s00268-001-0157-6.

LIDMAN D, DANIELSSON P, ABDIU A, et al . The functional result two years after a microsurgical penile replantation. Case report[J ] . Scand J Plast Reconstr Surg Hand Surg, 1999, 33(3): 325-328. DOI: 10.1080/02844319950159325.

GARG S, DATE S V, GUPTA A, et al . Successful microsurgical replantation of an amputated penis[J ] . Indian J Plast Surg, 2016, 49(1): 99-105. DOI: 10.4103/0970-0358.182257.

RAHEEM O A, MIRHEYDAR H S, PATEL N D, et al . Surgical management of traumatic penile amputation: a case report and review of the world literature[J ] . Sex Med, 2015, 3(1): 49-53. DOI: 10.1002/sm2.54.

BISWAS G. Technical considerations and outcomes in penile replantation[J]. Semin Plast Surg, 2013, 27(4): 205-210. DOI: 10.1055/s-0033-1360588.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

暂无数据