【摘要】：目的探討應(yīng)用腓腸神經(jīng)橋接移植修復(fù)陰莖背神經(jīng)阻斷術(shù)后神經(jīng)離斷的臨床療效。方法 2014年5月—2016年5月,采用腓腸神經(jīng)橋接移植修復(fù)陰莖背神經(jīng)阻斷術(shù)后神經(jīng)離斷患者23例�；颊吣挲g19~38歲,平均27歲。病程1~28個(gè)月,平均14個(gè)月。術(shù)前患者主要表現(xiàn)為陰莖性快感、冷熱感覺及觸覺敏感度減退等感覺障礙。21例患者自訴勃起障礙。所有患者激素水平正常,無其他器質(zhì)性疾病,無手術(shù)禁忌證。根據(jù)癥狀自評量表-SCL90評估,患者存在抑郁19例、焦慮16例,其中焦慮及抑郁共存15例;其余心理異常情況(社交障礙等)3例。術(shù)中發(fā)現(xiàn)缺損神經(jīng)總長度為1.0~1.5 cm。根據(jù)英國醫(yī)學(xué)研究院神經(jīng)外科學(xué)會(huì)感覺功能評定標(biāo)準(zhǔn),評定靜態(tài)兩點(diǎn)辨別覺、感覺分級情況,記錄性快感障礙、冷熱感覺及觸覺敏感度等主觀感覺情況;對陰莖背神經(jīng)阻斷術(shù)后勃起功能采用國際勃起功能指數(shù)-5(IIEF-5)問卷調(diào)查表進(jìn)行評估;應(yīng)用癥狀自評量表-SCL90進(jìn)行心理狀態(tài)評估。結(jié)果術(shù)后患者切口均Ⅰ期愈合。23例患者均獲隨訪,隨訪時(shí)間6~12個(gè)月,平均8個(gè)月。術(shù)后6個(gè)月性快感較術(shù)前明顯改善11例,部分改善5例;冷熱感覺及觸覺敏感度改善21例;各方面均無明顯改善1例。術(shù)后3、6個(gè)月患者靜態(tài)兩點(diǎn)辨別覺、感覺分級情況以及IIEF-5問卷調(diào)查表評定結(jié)果均較術(shù)前顯著改善,比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后6個(gè)月根據(jù)癥狀自評量表-SCL90評估,與術(shù)前相比,抑郁改善14例(73.68%),焦慮改善12例(75.00%),焦慮和抑郁共存改善12例(80.00%)。結(jié)論腓腸神經(jīng)橋接移植修復(fù)陰莖背神經(jīng)阻斷術(shù)后神經(jīng)離斷,可獲得較好療效。
[Abstract]:Objective to investigate the clinical effect of sural nerve bridging transplantation in the repair of nerve transection after dorsal penile nerve occlusion. Methods from May 2014 to May 2016, 23 patients with nerve transection after dorsal penile nerve occlusion were treated with sural nerve graft. The patients were 19 years old and 38 years old, with an average of 27 years old. The course of disease was 1-28 months (mean 14 months). Before operation, the patients mainly presented with sensorineural disorders such as penile pleasure, cold-hot sensation and decreased tactile sensitivity. 21 patients complained of erectile dysfunction. All patients with normal hormone levels, no other organic diseases, no surgical contraindications. According to symptom Checklist-SCL90 (SCL-90), there were 19 patients with depression, 16 patients with anxiety, 15 patients with anxiety and depression, and 3 patients with other mental disorders (social disorder, etc.). The total length of the nerve defect was found to be 1.0 to 1.5 cm. during the operation. According to the evaluation standard of sensory function of the Society of Neurosurgery of the British Medical Institute, subjective sensations such as static two-point discrimination, sensory grading, recording pleasure disorder, cold-hot sensation and tactile sensitivity were evaluated. The erectile function after penile dorsal nerve occlusion was assessed with the International erectile function Index-5 (IIEF-5) questionnaire, and the psychological status was evaluated by symptom Checklist-SCL90 (SCL-90). Results all of the 23 patients were followed up for 6 months and 12 months (mean 8 months). In 6 months after operation, sexual pleasure was improved in 11 cases, partial improvement in 5 cases, cold-heat sensation and tactile sensitivity improved in 21 cases, and no significant improvement in all aspects was found in 1 case. At 3 and 6 months after operation, the static two-point discrimination, sensory grading and IIEF-5 questionnaire were significantly improved compared with those before operation (P0.05). According to symptom Checklist-SCL90 (SCL-90), 14 cases (73.68%) improved depression, 12 cases improved anxiety (75.00%) and 12 cases improved both anxiety and depression (80.00%) 6 months after operation. Conclusion the peroneal nerve graft can be used to repair the nerve transection after dorsal penile nerve occlusion.
【作者單位】： 四川大學(xué)華西醫(yī)院美容整形-燒傷外科;
【分類號】：R699.8

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