CAJ | 학술논문

目的探讨治疗患者阴茎毁损性电烧伤的时机与适宜方法. 方法 1998年9月-2013年8月笔者单位收治13例阴茎毁损性电烧伤患者,通过换药清除坏死组织后,根据阴茎损伤程度,分别选择阴囊或腹部的局部皮瓣或瓦合皮瓣、前臂预制瓦合皮瓣、前臂游离皮瓣修复缺损或再造阴茎. 结果采用阴囊或腹部局部皮瓣修复的2例患者,皮瓣成活,伤口愈合良好;阴囊瓦合皮瓣修复的2例患者术后6～9个月发生尿道炎,经药物治疗而愈.该4例患者排尿和阴茎勃起功能均正常.以腹部瓦合皮瓣或前臂预制瓦合皮瓣修复的5例患者,皮瓣全部成活,2例伤口愈合良好;3例伤口发生不同程度裂开,经二三次修整缝合,伤口愈合.该5例患者阴茎均有勃起功能,但排尿时尿线欠流畅,3例已婚者能正常进行性生活.以前臂游离皮瓣行阴茎再造的4例患者,皮瓣成活,伤口愈合良好,其中1例发生尿瘘,经Ⅱ期修复治愈.该4例患者排尿均正常,其中2例阴茎残存部分海绵体者有一定的勃起功能,但4例患者均不能正常进行性生活.术后随访6～13个月,常态下阴茎长5.9～9.3 cm、周径8.4 ～10.0 cm,伤口瘢痕均不明显,9例患者自述勃起时有牵拉感. 结论阴茎毁损性电烧伤宜在清除坏死组织后进行皮瓣修复,其中阴茎海绵体和/或尿道海绵体小部分坏死,或伴尿道部分缺损者,采用阴囊或腹部局部皮瓣、阴囊瓦合皮瓣修复;尿道海绵体大部分或完全坏死伴尿道缺损者,采用腹部瓦合皮瓣或前臂预制瓦合皮瓣修复;阴茎与尿道海绵体大部分坏死伴尿道缺损或阴茎完全缺损者,采用前臂游离皮瓣行阴茎再造.
목적 탐토치료환자음경훼손성전소상적시궤여괄의방법. 방법 1998년9월-2013년8월필자단위수치13례음경훼손성전소상환자,통과환약청제배사조직후,근거음경손상정도,분별선택음낭혹복부적국부피판혹와합피판、전비예제와합피판、전비유리피판수복결손혹재조음경. 결과 채용음낭혹복부국부피판수복적2례환자,피판성활,상구유합량호;음낭와합피판수복적2례환자술후6～9개월발생뇨도염,경약물치료이유.해4례환자배뇨화음경발기공능균정상.이복부와합피판혹전비예제와합피판수복적5례환자,피판전부성활,2례상구유합량호;3례상구발생불동정도렬개,경이삼차수정봉합,상구유합.해5례환자음경균유발기공능,단배뇨시뇨선흠류창,3례이혼자능정상진행성생활.이전비유리피판행음경재조적4례환자,피판성활,상구유합량호,기중1례발생뇨루,경Ⅱ기수복치유.해4례환자배뇨균정상,기중2례음경잔존부분해면체자유일정적발기공능,단4례환자균불능정상진행성생활.술후수방6～13개월,상태하음경장5.9～9.3 cm、주경8.4 ～10.0 cm,상구반흔균불명현,9례환자자술발기시유견랍감. 결론 음경훼손성전소상의재청제배사조직후진행피판수복,기중음경해면체화/혹뇨도해면체소부분배사,혹반뇨도부분결손자,채용음낭혹복부국부피판、음낭와합피판수복;뇨도해면체대부분혹완전배사반뇨도결손자,채용복부와합피판혹전비예제와합피판수복;음경여뇨도해면체대부분배사반뇨도결손혹음경완전결손자,채용전비유리피판행음경재조.
Objective To explore the timing and suitable method of reconstructing penile defects caused by devastating electrical burn.Methods Thirteen patients with penile defects after devastating electrical burn,hospitalized from September 1998 to August 2013,were included in this study.After the necrotic tissues in the wounds were removed by dressing changes,a local or a hinge-like flap constructed from scrotum or abdominal wall,a prelaminated hinge-like flap from forearm,or a free forearm flap was selected,according to the injury degree of the penis,for the repair of the defect or reconstruction of penis respectively.Results The flaps survived and the wounds healed well in 2 patients repaired with local flaps from scrotum or abdominal wall.Urethritis occurred in 2 patients 6 to 9 months after the transplantation of hinge-like flaps from scrotum,and they were cured by appropriate drugs.Functions of urination and erection of penis were recovered in these 4 patients.All flaps survived in the 5 patients repaired with hinge-like flaps from abdominal wall or prelaminated flaps from forearm.The wounds in 2 patients healed; wound dehiscence occurred in the other 3 patients in different degrees,and they healed after suturing for 2 or 3 times.The function of erection of penis recovered in these 5 patients,but with discontinuity of urinary stream during urination.Among them,3 married patients enjoyed satisfactory sexual life.All free forearm flaps survived and the wounds healed well in 4 patients.Urinary fistula occurred in 1 patient,and it was repaired by a secondary operation.These 4 patients experienced normal urination function,but only 2 patients in whom corpus spongiosum partially remained retained the function of erection of penis to certain degree.All these 4 patients could not perform normal sexual intercourse.All patients were followed up for 6 to 13 months after surgery.Under ordinary state,the length of penis was 5.9-9.3 cm,and the circumference of penis was 8.4-10.0 cm.Wound scar was not obvious in all cases.Nine patients reported a restricted erection.Conclusions Penile defect caused by devastating electrical burn should be repaired with a suitable flap after necrotic tissues are removed with dressing change.To repair affected penis with necrosis of a small part of cavernous body and/or corpus spongiosum,or combined with urethra defects,local flaps from scrotum or abdominal wall or hinge-like flap from scrotum should be employed.To repair those with necrosis of a large part or the whole of corpus spongiosum combined with urethra defects,hinge-like skin flaps from abdominal wall or prelaminated flaps from forearm shoull be employed.In patients with necrosis of a large part of cavernous body and corpus spongiosum combined with urethra defect,or total loss of penis,free forearm flaps should be employed to reconstruct penis.