Li Gui-Zhong, Man Li-Bo, He Feng, Huang Guang-Lin
Department of Urology, Beijing Jishuitan Hospital, Beijing 100035, China.
Zhonghua Nan Ke Xue. 2013 Aug;19(8):722-6.
To evaluate the methods for the replantation of the amputated penis in Chinese men.
We performed a meta-analysis on the domestic literature relating replantation of the amputated penis, particularly its successful methods published from 1964 to January 2012.
We identified 109 reports on 111 cases of replantation of the amputated penis that met the inclusion criteria, including 103 adults and 8 children. The mean age, warm ischemia time and total ischemia time were 29 +/- 11 years (range 2 - 56 years), 5.2 +/- 5.7 hours (range 0 - 38 hours) and 6.3 +/- 5.7 hours (range 1 - 38 hours). Fifty-three of the cases were treated by microsurgery and 44 by non-microsurgery. Complications occurred in 81 (73%) of the cases, including ED in 14 cases, urethral stricture in 16, urinary fistula in 8, skin necrosis in 58 and skin sensory abnormality in 31. The incidences of ED, urethral stricture and urinary fistula exhibited significant differences between the microsurgery and non-microsurgery groups of the partial amputation patients (P < 0.05). The incidence of ED was correlated negatively with the number of anastomosed dorsal nerves (r = -0.3, P = 0.05), anastomosis of dorsal veins (r = -0.2, P = 0.02) and anastomosis of arteries (r = -0.2, P = 0.03), but positively with skin sensory abnormality (r = 0.4, P < 0.01), that of urethral stricture negatively with the anastomosis of dorsal nerves (r = -0.2, P = 0.02) and arteries (r = -0.2, P = 0.016), but positively with the anastomosis of corpus cavernosum (r = 0.3, P = 0.01), that of skin necrosis negatively with the total number of anastomosed blood vessels (r = -0.2, P = 0.04), and that of complications negatively with the number of anastomosed dorsal nerves (r = -0.3, P = 0.01), dorsal veins (r = -0.2, P = 0.04), arteries (r = -0.2, P = 0.023) and micro-anastomosis (r = -0.3, P < 0.05).
Early micro-anastomosis of the most possible penile dorsal veins, arteries and dorsal nerves is essential for the survival of the replanted penis and reduction of complications, and therefore can be regarded as a "standard" method for penile replantation in China.
评估中国男性阴茎离断再植的方法。
对国内有关阴茎离断再植的文献，尤其是1964年至2012年1月发表的成功方法进行荟萃分析。
我们确定了109篇关于111例阴茎离断再植的报告符合纳入标准，其中包括103名成年人和8名儿童。平均年龄、热缺血时间和总缺血时间分别为29±11岁（范围2至56岁）、5.2±5.7小时（范围0至38小时）和6.3±5.7小时（范围1至38小时）。53例采用显微外科治疗，44例采用非显微外科治疗。81例（73%）发生并发症，包括14例勃起功能障碍、16例尿道狭窄、8例尿瘘、58例皮肤坏死和31例皮肤感觉异常。部分离断患者的显微外科和非显微外科组之间，勃起功能障碍、尿道狭窄和尿瘘的发生率存在显著差异（P<0.05）。勃起功能障碍的发生率与吻合的背神经数量（r=-0.3，P=0.05）、背静脉吻合（r=-0.2，P=0.02）和动脉吻合（r=-0.2，P=0.03）呈负相关，但与皮肤感觉异常呈正相关（r=0.4，P<0.01）；尿道狭窄的发生率与背神经吻合（r=-0.2，P=0.02）和动脉吻合（r=-0.2，P=0.016）呈负相关，但与海绵体吻合呈正相关（r=0.3，P=0.01）；皮肤坏死的发生率与吻合血管总数呈负相关（r=-0.2，P=0.04）；并发症的发生率与吻合的背神经数量（r=-0.3，P=0.01）、背静脉（r=-0.2，P=0.04）、动脉（r=-0.2，P=0.023）和显微吻合（r=-0.3，P<0.05）呈负相关。
尽早对尽可能多的阴茎背静脉、动脉和背神经进行显微吻合，对于再植阴茎的存活和减少并发症至关重要，因此可被视为中国阴茎再植的“标准”方法。
