应用尿道海绵体黏膜组织瓣构建会阴前庭的临床研究

张连杰 张荣环 赵烨德 唐乙 胡卫敏 周强 陈祥云

[摘要]目的：探讨男跨女性别重置术中构建会阴前庭的手术方法。方法：保留新尿道口上方约3cm的尿道海绵体，长方形展开，上端与再造阴蒂连接，两侧与小阴唇内侧皮肤缝合，形成大小约3cm（长）×1.5cm（宽）的椭圆形会阴前庭外观。结果：82例男跨女性别重置术中应用此方法构建会阴前庭，术后尿道海绵体黏膜组织瓣全部成活，会阴前庭形态满意，其中6例患者术后发生会阴前庭区出血，找到出血点给予重新缝合后无出血。68例随访6个月以上，患者会阴前庭形态自然逼真，感觉良好。结论：应用尿道海绵体黏膜组织瓣构建会阴前庭，外形自然逼真，感觉良好，充分符合美学要求。此方法血运可靠、易掌握，是一种较好的术式选择。

[关键词]性别重置术;男跨女;易性症;会阴前庭;尿道海绵体;黏膜组织瓣

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2021）07-0005-03

Clinical Study on Construction of Perineal Vestibule with Corpus Cavernosum Mucosal Flap

ZHANG Lian-jie1，ZHANG Rong-huan2，ZHAO Ye-de1，TANG Yi1，HU Wei-min1，ZHOU Qiang1，

CHEN Xiang-yun1

（1.Department of Plastic Surgery;2.Department of Obstetrics and Gynecology，Hongkou District of the Changhai Hospital，Naval Medical University，Shanghai 200081，China）

Abstract： Objective  To explore a method for perineal vestibuleconstruction in male-to-female genderconfirmation surgery. Methods  The corpus cavernosum about 3cm above the new urethral orifice was retained and expanded in a rectangular shape.The upper edge was connected with the reconstructed clitoris， and the two sides are sutured with the labia minora， the constructed perineal vestibule was oval in shape of 3cm（length）×1.5cm（width）. Results  Perineal vestibule of 82 cases in male-to-female genderconfirmation surgery were constructed by this method， all corpus cavernosum mucosal flap survived well with satisfied result. Six patients had perineal vestibule hemorrhage after operation. No bleeding was found after the bleeding point was re-sutured. 68 cases were followed up from more than 6 months， the perineal vestibule hadrealistic appearance and were sensitive. Conclusion  The appearance of perineal vestibule accorded with aesthetic requirements. It has been a good choice to construct perineal vestibule with corpus cavernosum mucosal flap.

Key words： gender replacement surgery; male-to-female; transsexualism; perineal vestibule; corpus cavernosum of urethra; mucosal tissue flap

隨着社会文明的进步，易性症患者已经越来越多的被人们所理解，性别重置手术是治疗易性症的主要方法[1]。阴道成形术是男跨女易性症患者性别重置的主体手术，以往文献的报道主要集中在阴道成形及大小阴唇成形的处理上，而构建会阴前庭的手术方法报道较少[2-4]。随着患者对会阴部外形美观要求的日渐提高，构建一个外观自然逼真、感觉良好的会阴前庭已引起越来越多的重视[5-6]。2017年2月-2019年12月，笔者科室共收治男跨女易性症患者82例，均已完成性别重置手术构建会阴前庭，获得良好效果。……