Morrison Shane D, Shakir Afaaf, Vyas Krishna S, Remington Austin C, Mogni Benjamin, Wilson Stelios C, Grant David W, Cho Daniel Y, Rahnemai-Azar Amir A, Lee Gordon K, Friedrich Jeffrey B, Mardini Samir
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
J Reconstr Microsurg. 2017 May;33(4):227-232. doi: 10.1055/s-0036-1597567. Epub 2016 Dec 21.
Penile replantation is an uncommonly performed procedure, which can alleviate physical and psychosocial sequelae of penile amputation. This study critically appraises the current literature on penile replantation. A comprehensive literature search of the Medline, PubMed, and Google Scholar databases was conducted with multiple search terms related to penile replantation. Data on outcomes, complications, and patient satisfaction were collected. A total of 74 articles met inclusion criteria. One hundred and six patients underwent penile replantation, but outcome, complication, and satisfaction data were not standardized across all patients. Penile amputation most often resulted from self-mutilation or trauma. The majority were complete amputations (74.8%). Full sensation was maintained in 68.4% of patients. Most reported adequate urinary function (97.4%) and normal erection (77.5%). Skin necrosis (54.8%) and venous congestion (20.2%) were the most common complications. Urethral stricture (11.0%) and fistula (6.6%) were common urethral complications. Most (91.6%) patients reported overall satisfaction although there was a lack of patient-reported outcomes. Multivariate analysis suggested that complete amputation (β = 3.15, 95% CI 0.41-5.89, = 0.024), anastomosis of the superficial dorsal artery (β = 9.88, 95% CI 0.74-19.02, = 0.034), and increasing number of nerves coapted (β = 1.75, 95% CI 0.11-3.38, = 0.036) were associated with favorable sexual, urinary, and sensation outcomes. Increasing number of vessels anastomosed (β = -3.74, 95% CI -7.15 to -0.32, = 0.032) was associated with unfavorable outcomes. Although penile replantation is associated with complications, it has a high rate of satisfaction and efficacy. Coaptation of multiple nerves and anastomosis of the superficial dorsal artery should be completed.
阴茎再植术是一种不常施行的手术，它可以减轻阴茎离断后的生理和心理社会后遗症。本研究对当前关于阴茎再植术的文献进行了批判性评价。通过使用与阴茎再植术相关的多个检索词，对Medline、PubMed和谷歌学术数据库进行了全面的文献检索。收集了有关结果、并发症和患者满意度的数据。共有74篇文章符合纳入标准。106例患者接受了阴茎再植术，但所有患者的结果、并发症和满意度数据并不统一。阴茎离断最常见的原因是自残或外伤。大多数是完全离断（74.8%）。68.4%的患者保留了完全感觉。大多数患者报告排尿功能正常（97.4%）且勃起功能正常（77.5%）。皮肤坏死（54.8%）和静脉淤血（20.2%）是最常见的并发症。尿道狭窄（11.0%）和瘘管（6.6%）是常见的尿道并发症。大多数（91.6%）患者报告总体满意，尽管缺乏患者报告的结果。多变量分析表明，完全离断（β = 3.15，95%CI 0.41 - 5.89，P = 0.024）、阴茎背浅动脉吻合（β = 9.88，95%CI 0.74 - 19.02，P = 0.034）以及吻合神经数量增加（β = 1.75，95%CI 0.11 - 3.38，P = 0.036）与良好的性、排尿和感觉结果相关。吻合血管数量增加（β = -3.74，95%CI -7.15至 -0.32，P = 0.032）与不良结果相关。虽然阴茎再植术会伴有并发症，但它具有较高的满意度和疗效。应完成多条神经的吻合和阴茎背浅动脉的吻合。
