阴茎折断的诊断与治疗(附13例报告)

目的探讨阴茎折断的诊断与治疗。方法回顾性分析13例阴茎折断病人的临床资料和随访情况。结果13例均临床表现典型，除1例门诊误诊外，12例依据病史与体检确诊。13例均进行阴茎触摸和B型超声检查，发现局限性血肿11例，发现海绵体破裂口8例。13例均行急诊手术治愈，10例获7月至8年术后随访：无疼痛、硬结和成角，8例手术后1-6月恢复正常性生活，1例性生活减退，1例70岁病人性生活明显减退。绪论典型病史和体征是阴茎折断的主要诊断依据，阴茎触诊和B型超声检查可以发现海绵体损伤和血肿部位、指导手术切口部位。急诊手术治疗可以减少并发症的发生。     

阴茎折断的诊断与治疗(附14例报告)

目的探讨阴茎折断的诊断与治疗方法。方法14例阴茎折断患者,10例采用半环行小切口、3例采用冠状沟近侧环行切口行阴茎血肿清除加白膜修补术,1例保守治疗。结果14例随访1~4年,13例阴茎无勃起不坚、勃起弯曲、勃起疼痛,性生活满意,无尿道狭窄,1例保守治疗者伤后2年阴茎局部可扪及硬结,但性功能基本正常。结论阴茎折断诊断不难,B超检查可准确定位白膜损伤部位及裂伤口大小,手术治疗是首选方法,疗效满意,改良小切口修补术具有简单、创伤小、手术时间短的优点,值得临床推广。     

中、重型尿道下裂的一期手术治疗

目的总结应用纵行带蒂岛状包皮瓣行一期尿道成形术治疗中、重型尿道下裂的经验。并评价其疗效。方法本组54例，阴茎型44例，阴茎阴囊型10例。均用纵行带蒂岛状包皮瓣行一期尿道成形术，平均重建尿道长度2．8cm。结果一期手术成功率为92．6％（50／54），尿瘘发生率为7．4％（4／54）。所有患者术后1个月复查1次，48例患者随访3个月至2年，阴茎外观及排尿功能均良好。结论纵行带蒂岛状包皮瓣行一期尿道成形术，对伴有阴茎下曲、尿道板发育不良的阴茎型及阴茎阴囊型中、重型尿道下裂患者，治疗效果良好。     

未行阴茎固定的改良devine术治疗隐匿型阴茎32例效果观察

目的观察未行阴茎固定的改良devine术治疗隐匿型阴茎的效果，探讨改良devine术治疗隐匿行阴茎手术中进行阴茎固定有无必要。方法分析采用未行阴茎固定的改良devine术治疗的32例隐匿型阴茎患者的临床资料，并对该术式进行综合评价。结果32例中阴茎平均延长2．2em。本组无严重的术中及术后并发症，均有不同程度的包皮水肿，2—4周消退。术后随访6个月～1年，阴茎均未见回缩，无排尿异常，勃起功能正常。结论改良devine术治疗隐匿型阴茎手术中阴茎固定并非必要步骤，未行阴茎固定的改良devine术治疗隐匿型阴茎疗效确切，阴茎显露满意且不回缩，同时具有手术时间短、创伤小、操作简便，并发症少等优点。     

阴囊推进式皮瓣治疗儿童隐匿性阴茎临床分析

目的探讨儿童隐匿性阴茎的手术治疗方式,提高对该疾病的认识及临床治疗的效果。方法对18例隐匿性阴茎患儿采用阴囊推进式皮瓣手术矫正,术中将阴茎包皮脱套至阴茎根部,切除多余包皮内板,识别并剔除阴茎体部发育不良的条索状组织,阴囊皮瓣向阴茎推进,术后对所有患者进行随访。结果本组患者术后随访3-12个月,手术均获得成功,无一例复发,无皮肤长期水肿、坏死、勃起疼痛等并发症,术后阴茎显露及外观满意,发育良好,排尿及勃起功能正常。结论本术式纠正了隐匿性阴茎的病理改变,术后阴茎功能和形态良好,是治疗隐匿性阴茎的理想术式。     

中、重型尿道下裂的一期手术治疗

目的 总结应用纵行带蒂岛状包皮瓣行一期尿道成形术治疗中、重型尿道下裂的经验,并评价其疗效.方法 本组54例,阴茎型44例,阴茎阴囊型10例.均用纵行带蒂岛状包皮瓣行一期尿道成形术,平均重建尿道长度2.8 cm.结果 一期手术成功率为92.6%(50/54),尿瘘发生率为7.4%(4/54).所有患者术后1个月复查1次,48例患者随访3个月至2年,阴茎外观及排尿功能均良好.结论 纵行带蒂岛状包皮瓣行一期尿道成形术,对伴有阴茎下曲、尿道板发育不良的阴茎型及阴茎阴囊型中、重型尿道下裂患者,治疗效果良好.     

阴茎脱套固定术治疗隐匿阴茎效果探究

目的：探讨分析对隐匿阴茎患儿,分别采用脱套固定术与Devine术,哪种手术方式治疗效果更好。方法回顾分析76例患儿的治疗,其中采用阴茎脱套固定术与Devine术进行隐匿阴茎治疗的患儿各38例,前者归入A组,后者归入B组,对比两组疗效。结果术后两组患儿阴茎状况均良好,均无包皮坏死等并发症出现,然而A组患者手术疗效更好,总有效率为97．4％,高于B组患者78．9％的数据,差异显著,具备统计学意义（P＜0．05）。结论在治疗隐匿阴茎患者时,脱套固定术的临床效果明显优于Devine术,更值得采用。     

白血病并发阴茎异常勃起的外科处理

目的 探讨和分析白血病并发阴茎异常勃起的外科处理方法和特点.方法 5例白血病并发阴茎异常勃起的患者行阴茎海绵体针刺对流灌洗抽吸术、尿道海绵体阴茎海绵体分流术、硬膜外麻醉等外科治疗,并配合白血病化疗,观察其疗效.结果 5例患者经过积极处理均取得良好的治疗效果,3例经过1次阴茎海绵体针刺对流灌洗抽吸术后阴茎异常勃起得到纠正,1例经2次阴茎海绵体针刺对流灌洗抽吸术并配合1次硬膜外麻醉阴茎异常勃起消退,1例行尿道海绵体阴茎海绵体分流术后阴茎异常勃起消退.所有患者术后均未再发阴茎异常勃起.结论 阴茎海绵体针刺对流灌洗抽吸术、尿道海绵体阴茎海绵体分流术、硬膜外麻醉等配合白血病化疗治疗白血病并发阴茎异常勃起效果良好,方法简单可行,具有很强的实用性,临床可以选择使用.     

短小、残缺阴茎可经手术延长

湖北医学院整形外科自1984年开始,通过尸体解剖和临床研究,设计出切断阴茎韧带延长阴茎的手术方法,可使阴茎海绵体延长3～6厘米,而且不影响正常感觉和勃起功能。目前他们已用此种方法治疗了115例患者,术前阴茎平均长度5厘米左右,术后平均长度7～9厘米,治疗效果均满意。     

肩锁关节脱位内固定术后锁骨钩钢板断裂分析

目的 观察运用锁骨钧钢板对肩锁关节脱位进行切开复位内固定手术的临床治疗效果.方法 从2001年5月至2011年5月运用以上方法治疗了20例肩锁关节脱位的患者.平均年龄43岁,随访时间6～16个月(平均11个月).结果 除1例钢板断裂外,其它患者均获得良好复位和固定.结论 锁骨钩钢板治疗肩锁关节脱位要防止钢板折断这一少见并发症.     

Cancer de la verge et laser dioxyde de carbone. À partir de six cas

ObjectiveThe aim of this study is to show how useful the CO₂ laser can be in the resection, diagnosis and treatment of penile cancer.Materials and methodsThis was a retrospective study of six cases of penile cancer admitted to the department of urology in the hospital of Bourg-en-Bresse between January 2000 and December 2005, amongst 20 suspicious penile lesions resected using CO₂ laser. The mean age of our patients was 65.66 ranging from 46 to 82 years. The patients had an history of phimosis (3 cases), lichen sclerous et atrophicus (2 cases), condyloma latum (1 case) and smoking (1 case). The tumour was located in the glans in 4 cases, in the collum glandis (1 case), in the preputium (1 case) and in the penile body (1 case). In all, 5 patients underwent circumcision before treatment. The histological examination of the resected segment evidenced squamous cell carcinoma in 4 cases, epidermoid carcinoma of the bulboid-urethral membrane in 1 case, erythroplasia of Querat in one case, and dysplasia of lichen sclerous et atrophicus of the preputium in one case.ResultsResection using CO₂ laser was sufficient treatment in 4 cases when the tumours were classified as superficial, with minimum risk, good healing and resumption of normal, or even improved sexual activity (pTa, pT1, G1, G2). One patient developped stenosis in the urethral maetus, dilated by the urethra sound. The resection was followed by amputation of the penis and bilateral superficial, then deep lymph node dissection, with additional radio-chemotherapy for one case of infiltrating tumour of the penis with lymph node metastases (Pt2N3G3MO) — this patient has been in full remission for 11 months — and for the case of bulboid-urethral membrane tumour with extension to the corpus cavernosa and corpus spongiosum. The CO₂ laser was used purely for diagnosis purposes, and the treatment was full amputation of the penis, left orchidectomy, cystoprostatectomy with Bricker derivation. This patient died 5 months after surgery.ConclusionWe recommend the use of scalpel effect CO₂ laser for early screening of penile cancer amongst persistent penile lesions. Used as treatment, it can be sufficient for superficial tumours with a free marginal resection (at least 5 mm) with good cosmetic results, good haemostasis and a rapid resumption of normal sexual activity.     

MRI与MSCT在膝关节隐匿性骨折中的应用

目的对比MRI与多层螺旋CT(MSCT)对膝关节隐匿性骨折的诊断效果。方法回顾性分析2017年5月—2019年5月我院158例经手术或关节镜确诊的隐匿性膝关节骨折患者的临床资料。158例患者均采取MRI与MSCT检查,观察膝关节隐匿性骨折的MSCT与MRI征象。同时,比较MSCT与MRI的诊断的符合率,以及诊断的灵敏度、特异度、阳性预测值、阴性预测值。结果MSCT检查:骨折线影或骨质呈持续性中断,局部骨质缺损与移位骨折吻合。MRI检查:T1WI序列呈片状略低或不均匀低信号,T2WI序列则为略高或高信号,STIR序列边缘欠清晰,呈高信号,各序列像未见明显的线样略高信号或低信号。本组患者经MRI诊断的符合率99.17%高于MSCT90.00%(P<0.01),且诊断的灵敏度、特异度、阳性预测值与阴性预测值均高于MSCT,结果对比差异具有统计学意义(P<0.05)。结论相较于MSCT,MRI对膝关节隐匿性骨折的诊断效果更为理想,所以对于X线诊断为阴性且高度疑似膝关节隐匿性骨折的患者,应及时给予MRI检查,以便保障后续治疗效果。     

Subjective and penile plethysmography responses to aversion therapy for homosexuality: A partial replication

Forty patients were randomly assigned to receive apomorphine aversion or avoidance conditioning to reduce homosexual impulses. Prior to and following treatment, they were shown a film containing pictures of nude women preceded by pictures of a red circle and of nude men preceded by a green triangle. At 2 weeks following treatment, the patients showed significantly less penile volume increase to the pictures of men and penile volume decrease to the pictures of women, but no penile volume increase to the pictures of women. The changes in penile volume response of each patient correlated with the reduction in homosexual feeling he reported at follow-up 6 months later. There was no weakening of the change in penile volume responses at this time. Some statistically significant relationships were found between various measures of each patient's response to treatment and conditionability, but these were not present both at 2 weeks following treatment and at subsequent follow-up. Also, they differed from the relationships which were found to be statistically significant in an earlier study. It was concluded that they were chance relationships. Approximately half the patients reported possible or definite reduction in homosexual feeling and an increase in heterosexual feeling after 6 months or longer. The results are comparable with those of a previous study using apomorphine conditioning and aversion-relief therapy to treat homosexuality.     

肱骨近端移位骨折的治疗及康复

目的探讨肱骨近端移位骨折的治疗方法及效果。方法对近5年来诊治的43例肱骨近端移位骨折患者进行回顾性分析．非手术治疗12例，手术治疗31例。结果本组患者随访时间6个月-3年，均临床愈合，3例发生肱骨头坏死。按黄公怡肩关节评分标准进行治疗效果评估，手术组和非手术组的肩关节功能优良率分别为80．6％和75％。结论对肱骨近羰移位骨折应根据不同的骨折类型和患者的全身情况来选择不同的治疗方法，以恢复肩关节的功能为治疗的主要目的。     

尿道板纵切卷管成形治疗先天性尿道下裂

目的探讨尿道板纵切卷管成形术治疗先天性尿道下裂的临床效果。方法选择我院2009年1月至2011年12月收治的39例先天性尿道下裂患者,其中,31例（79.49%）为阴茎体型,5例（12.82%）为阴茎阴囊型,3例（7.69%）为阴囊型。所有患者采用尿道板纵切卷管成形术治疗,对患者的临床治疗效果进行观察与分析。结果 39例先天性尿道下裂患者进行尿道板纵切卷管成形术的手术时间为75～100min,平均手术时间85min。37例患者手术成功,手术成功率为94.87%,1例（2.56%）患者出现尿瘘,行修补术后患者痊愈。1例（2.56%）患者出现尿道狭窄,定期进行尿道扩张后患者痊愈。所有患者对手术后阴茎外观表示满意,满意度为100%。结论尿道板纵切卷板尿道成形术方法简单,患者术后并发症较少、阴茎外形恢复正常,具有重要的应用价值。     

探讨可膨胀髓内钉治疗四肢骨折的方法和临床效果

目的：对于四肢骨折的患者,分析采用可膨胀的髓内钉进行治疗的方法,并观察其效果。方法：收集笔者所在医院从2009年1月一2012年1月的50例四肢骨折患者,皆为长骨骨折。采用可膨胀的髓内钉进行治疗,将其作为观察组,选择一般资料不存在显著差异的50例四肢骨折患者作为对照组,并采用常规四肢骨折手术进行治疗。对两组患者手术过程出血的量、手术时间、骨折愈合的时间、X线透视的次数及手术后并发症进行分析。结果：经过治疗,观察组患者手术过程中出血的量明显少于对照组,且手术时间、骨折愈合的时间均比对照组短,x线透视的次数及手术后并发症明显少于对照组,比较差异均有统计学意义（P〈O．05）。结论：对于四肢骨折的患者,采用可膨胀的髓内钉进行治疗,效果良好,且操作简单,有利于降低并发症发生概率,促进患者骨折的愈合,是四肢骨折患者l临床治疗的有效方式,值得推广应用。     

儿童肱骨外髁骨折58例治疗分析

目的探讨儿童肱骨外髁骨折的诊治及并发症的预防。方法对34例Ⅰ型骨折进行非手术治疗28例非手术治疗成功,6例5 15 d发现骨片移位接受手术治疗;11例Ⅱ型骨折,2例非手术治疗成功,9例手术治疗;13例Ⅲ、Ⅳ型骨折和陈旧性骨折病例均手术治疗;58例中共28例手术切开复位内固定治疗。结果非手术治疗的30例中,1例Ⅱ型骨折出现肘内翻;急性、亚急性手术治疗24例中,5例轻度肱骨外髁隆凸,2例轻度肘关节功能受限,1例肱骨小头及滑车坏死;陈旧性骨折手术治疗4例中,2例效果满意,1例肘关节功能受限,1例骨不连。结论儿童肱骨外髁骨折治疗的关键是争取早期解剖复位,防止陈旧性骨折的发生。     

切开复位内固定治疗重症胸外伤肋骨骨折效果分析

目的探析对重症胸外伤肋骨骨折患者实施切开复位内固定治疗后的效果。方法选取本院诊治的60例重症胸外伤肋骨骨折患者,诊治时间为2016年12月—2019年5月,根据治疗情况将患者随机分为两组,比对组患者30例和预见组患者30例,其中比对组患者进行常规保守治疗,预见组采用切开复位内固定进行治疗,观察比较两组患者治疗前后视觉模拟评分、骨折康复时间和治疗有效率、并发症发生率。结果预见组患者治疗有效率(96.67%)高于比对组(80.00%),并发症发生率(6.67%)低于比对组(26.67%)。P<0.05,差异有统计学意义;预见组患者治疗后视觉模拟评分低于比对组,骨折康复时间少于比对组,P<0.05,差异有统计学意义。结论对重症胸外伤肋骨骨折患者实施切开复位内固定治疗,可以提高临床治疗效果,改善患者视觉模拟评分,加快患者康复,降低并发症的发生。     

手术治疗同侧股骨干合并股骨颈骨折分析

目的 探讨手术治疗同侧股骨干合并股骨颈骨折的方法和疗效.方法 2000年12月至2007年3月收治13例同侧股骨干合并股骨颈骨折患者,采用股骨重建钉治疗7例,采用逆行髓内钉加空心螺纹钉治疗3例,由于漏诊,顺行髓内钉固定后加空心螺纹钉治疗3例.结果 13例患者均获得随访,随访时间18个月至5年.1例患者术后20个月股骨干骨折未愈合,予以再次手术内固定加植骨治疗,6个月后愈合;1例股骨颈骨折不愈合,行人工全髋关节置换术;其余均一期愈合.结论 同侧股骨干合并股骨颈骨折发生率较低,漏诊率较高,应根据股骨干的骨折部位,选择合适的治疗方法.     

Effects of yohimbine on sexual experiences and nocturnal penile tumescence and rigidity in erectile dysfunction

The therapeutic effect of the α₂-antagonist yohimbine in erectile dysfunction was studied in a double-blind placebo-controlled design. Thirty-one male patients underwent extensive clinical, urological, and psychiatric diagnosis and were dichotomically classified into an organic and a nonorganic subgroup. Following a 1-week placebo run-in period, patients were randomly assigned to a placebo or a verum group (yohimbine 15 mg daily) for a treatment period of 7 weeks. The Clinical Global Impression (CGI) scale was used as the primary efficacy parameter. Additionally, nocturnal penile tumescence and rigidity (NPTR) were measured. Global assessment of erectile function applying the CGI scale revealed, beyond a placebo effect in both organic and nonorganic patients, a therapeutic effect in the subgroup of nonorganic patients, with a significantly greater improvement in the yohimbine group compared to the placebo group. No superiority of yohimbine compared to placebo was found in the organic patients. These findings on the subjective level had no correlate in the NPTR recordings. The NPTR parameters were unchanged under yohimbine treatment in both the nonorganic and organic subgroup. No interrelation was found between subjective improvement and NPTR alterations. Polysomnographic control of the NPTR registrations ensured that the duration of REM sleep under treatment was not influenced. Study supported by Kali-Chemie GmbH, Hannover, Germany