Reconstructive Management Pearls for the Transgender Patient
Reconstructive Management Pearls for the Transgender Patient
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DOI：
10.1007/s11934-018-0795-y
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发表时间：
2018-06-01
影响因子：
2.6
通讯作者：
Zhao, Lee C.
中科院分区：
文献类型：
--
作者：
Dy, Geolani W.;Sun, Jeff;Zhao, Lee C.
越来越多的跨性别患者正在寻求性别肯定的生殖器重建手术（GRS）。这些复杂的手术具有很高的并发症发生率。我们描述了GRS常见的手术陷阱和减少并发症的方法。最近的研究结果阴茎内翻阴道成形术具有良好的美容和功能效果。机器人辅助解剖可以最大限度地降低直肠损伤的风险。由于年轻的跨性别人群选择青春期抑制，阴道腔内衬的替代来源，如肠道阴道成形术，可能会更广泛地使用。由于微血管技术在阴茎成形术中的应用，跨男性个体有可能获得有感觉的新阴茎和插入性性交。尿道并发症是常见的和具有挑战性的管理;使用皮瓣覆盖技术可以尽量减少缺血相关的狭窄，假体放置的创新需要适应neopallus anatomy.Summary越来越多的变性人正在寻求生殖器重建。需要不断创新手术技术以改善患者结局。
Purpose of Review A growing number of transgender patients are seeking gender-affirming genital reconstructive surgery (GRS). These complex procedures have high complication rates. We describe common surgical pitfalls in GRS and approaches for minimizing complications.Recent Findings Penile inversion vaginoplasty has been associated with excellent cosmetic and functional outcomes. A robotic-assisted dissection may minimize risk of rectal injury. As a younger transgender population chooses pubertal suppression, alternative sources for lining the vaginal canal, such as enteric vaginoplasties, may be more widely utilized. Since adoption of microvascular techniques in phalloplasty, transmasculine individuals have potential for a sensate neophallus and penetrative intercourse. Urethral complications are common and challenging to manage; techniques using flap coverage may minimize ischemia-related strictures, innovations in prosthesis placement require adaptations to neophallus anatomy.Summary A growing number of transgender individuals are seeking genital reconstruction. Ongoing innovation in surgical technique is needed to improve patient outcomes.