Austoni E, Colombo F, Mantovani F, Patelli E, Fenice O
Institute of Urology, University of Milano, Italy.
Arch Ital Urol Androl. 1995 Dec;67(5):359-64.
The radical surgical option we propose for Peyronie's disease consists in removing the sclero-hyanolitic focus (plaque) and replacing it by an autologous dermal graft taken from the upper outer thigh area. Between 1981 and 1994, we operated 564 patients with Induration penis plastica (IPP), 418 of whom underwent plaque excision and dermal grafting. All could be assessed at two-year follow-up. Two main complications were observed: penile flexure relapse (71 Pts, 17% of cases), and erectile dysfunction with decreased corporal rigidity (84 Pts, 20% of cases). A mild deviation of the penis can occur some months after surgery and it is not due to disease progression (as it should have evolutive characteristics) but is mere scar retraction (44 Pts, 76% of examined relapsed flexures). The degree of this graft retraction is linked to the individual's histologic response and can be due to an idioptic tissular response or to an insufficient size of the patch. In some cases, the post-op penile flexure can result from a progression of disease (14 Pts, 24% of examined relapses flexures) and can be due either to a new "focus" or to an incomplete removal of the previous plaque. As the patient will date the onset of a possible postoperative erectile deficit from the time of the operation, it is advisable to assess preoperatively the real erectile ability of all patients. Furthermore, a post-op impaired erectile response (84 Pts, 20%) could result from a subalbuginear fibrosis of the erectile tissue that leads to a caverno-occlusive dysfunction (60%). In more than 35% of patients we found a psychogenic component, due to post-surgical stress, that involves an adrenergic hypertone with peripherical vasoconstriction. In few cases (4%) the post-op erectile dysfunction is the consequence of peroperative arterial damages that results in hypoaesthesia of the glans (injury of dorsal arteries) or in failure to obtaining corporal rigidity (damage of cavernosal arteries). A review of our experience involving plaque excision and dermal grafting led us to propose this option in case of mechanical disturbance during coitus and when the association of erectile dysfunction can be excluded.
我们针对佩罗尼氏病提出的根治性手术方案包括切除硬化性玻璃样变病灶（斑块），并用取自大腿上外侧区域的自体真皮移植物进行替代。1981年至1994年间，我们为564例阴茎硬结症（IPP）患者实施了手术，其中418例接受了斑块切除和真皮移植。所有患者均在两年随访时接受评估。观察到两种主要并发症：阴茎弯曲复发（71例，占病例的17%），以及伴有海绵体硬度降低的勃起功能障碍（84例，占病例的20%）。术后数月可能会出现阴茎轻度偏斜，这并非疾病进展所致（因为疾病应具有渐进性特征），而仅仅是瘢痕收缩（44例，占检查复发弯曲的76%）。这种移植物收缩的程度与个体的组织学反应有关，可能是由于特发性组织反应或补片尺寸不足。在某些情况下，术后阴茎弯曲可能是疾病进展所致（14例，占检查复发弯曲的24%），可能是由于新的“病灶”或先前斑块切除不完全。由于患者会将术后可能出现的勃起功能障碍的起始时间追溯到手术之时，因此术前评估所有患者的实际勃起能力是可取的。此外，术后勃起反应受损（84例，占20%）可能是由于勃起组织的白膜下纤维化导致海绵体闭塞功能障碍（60%）。在超过35%的患者中，我们发现了心理因素，这是由于手术应激导致的，涉及肾上腺素能亢进和外周血管收缩。在少数情况下（4%），术后勃起功能障碍是术中动脉损伤的结果，导致龟头感觉减退（背动脉损伤）或无法获得海绵体硬度（海绵体动脉损伤）。回顾我们涉及斑块切除和真皮移植的经验，我们建议在性交时出现机械性干扰且可排除勃起功能障碍合并存在的情况下采用此方案。
