脱细胞异体补片移植阴茎增粗术后患者决策后悔分析

doi:10.19723/j.issn.1671-167X.2020.04.015

摘要/Abstract

摘要：

目的: 探究接受脱细胞异体补片移植阴茎增粗术(penile girth enhancement with acellular dermal matrix, PGE with ADM)的患者术后决策后悔现状及潜在预测指标,为优化该类患者决策制定过程提供依据。方法: 纳入78例在2016年6月至2019年1月于北京大学人民医院及协作医院接受PGE with ADM手术的患者。由同一名医师在术前1周测量患者阴茎周长,并以住院焦虑和抑郁量表(hospital anxiety and depression scale,HAD)、国际勃起功能指数(international index of erectile function, IIEF)和视觉化模拟阴茎印象评分(visualized penile image, VPI)评估患者心理负担、勃起功能和阴茎外观。所有患者于术后3个月接受随访,采用决策后悔量表(decision regret scale, DRS)评价患者决策后悔情况。应用多因素方差分析探究决策后悔预测指标,数据使用SPSS 24.0软件进行分析。结果: 术前患者平均阴茎周长为(8.29±0.30) cm,术后平均阴茎周长增至(9.46±0.29) cm(t=76.28, P< 0.01)。术后患者焦虑及抑郁子量表得分均显著下降,分别为2.8±1.3和3.0±1.2(t=19.28, P< 0.05; t=20.67, P< 0.05)。术后患者VPI平均得分增加3.7±1.1(t=30.63, P< 0.05)。用IIEF来评价勃起功能,干预前后IIEF得分无明显变化(t=1.60, P=0.11)。29例(38.2%)患者在一定程度上出现决策后悔,平均DRS评分为27.6±38.2。DRS评分与VPI评分呈负相关(r=-0.348, P< 0.01), 与Anxiety 得分(r=0.760,P< 0.01)和Depression得分呈正相关(r=0.471, P< 0.01), 与IIEF量表得分不具备相关性(r=0.02, P=0.867),多因素方差分析提示年收入高(> 120 000元)和本科以上教育水平的患者更容易发生术后决策后悔(P< 0.01)。结论: 脱细胞异体补片移植阴茎增粗术可以增加患者阴茎周长并减轻患者的心理负担,但术后决策后悔率相对较高。高收入、高教育水平的患者更易产生决策后悔,提示该人群在术前沟通时需要额外的决策支持。

关键词: 决策后悔, 阴茎增粗术, 脱细胞补片

Abstract:

Objective: To evaluate decision regret among patients receiving penile girth enhancement with acellular dermal matrix (PGE with ADM) and to investigate the potential indicators for decisional regret so as to facilitate the decision-making process for this special group. Methods: In the study, 78 patients receiving PGE with ADM from Jun. 2016 to Jan. 2019 at Peking University People’s Hospital and cooperative hospitals were eligible. Penile girth was taken by only one surgeon 1 week before surgery. Hospital anxiety and depression scale (HAD), international index of erectile function (IIEF) and a 10 cm long visual analogue scale named visualized penile image (VPI) were applied to measure psychological burden, erectile function and satisfaction with penile image respectively at the same time. All the patients were followed up for 3 months. Decision regret scale (DRS) was adopted for measuring decisional regret. Multivariate analysis of variance was applied to investigate the potential indicators for regret. Data analysis process was conducted with SPSS (version 24.0; SPSS, Chicago, IL, USA). Results: Mean penile girth recorded before intervention was (8.29±0.30) cm and increased to (9.46±0.29) cm post surgery (t=76.28, P< 0.01). As for both subscales of HAD measuring psychological burden, a signi-ficant reduction in the mean score was seen, that is, 2.8±1.3 (t=19.28, P< 0.05) for anxiety and 3.0±1.2 (t=20.67, P< 0.05) for depression, respectively. The average score of VPI increased by 3.7±1.1 (t=30.63, P< 0.05). There was no significant change in the average score of IIEF measuring erectile satisfaction (t=1.60, P=0.11). Twenty-nine (38.2%) patients expressed regret to some degree, and the mean DRS score was 23.4±14.8. The scores of DRS correlated negatively with scores of visualized penis image (r=-0.348, P< 0.01), and positively with scores of anxiety (r=0.760, P< 0.01) and depression subscale (r=0.471, P< 0.01). The scores of DRS was irrelevant to those of IIEF (r=0.02, P=0.867). The patients with high annual income (> 120 000 yuan) and education level above undergraduate were more prone to experience decision regret after intervention (P< 0.01). Conclusion: PGE with ADM did augment penile girth and lower psychological burden, the regret rate of which was acceptably low among the patients. High income and good education might indicate more post-operative regret. Additional decision-making aids should be offered to patients with high income and education level above high school.

Key words: Decision regret, Penile girth enhancement, Acellular dermal matrix

中图分类号:

R699.8

张春龙,李赫,李清,白文俊,徐涛,张晓威. 脱细胞异体补片移植阴茎增粗术后患者决策后悔分析[J]. 北京大学学报（医学版）, 2020, 52(4): 678-683.

Chun-long ZHANG,He LI,Qing LI,Wen-jun BAI,Tao XU,Xiao-wei ZHANG. Decision regret analysis among Chinese patients receiving penile girth enhancement with acellular dermal matrix[J]. Journal of Peking University (Health Sciences), 2020, 52(4): 678-683.

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Categories	Number	%	Decision regret	F^*	P^*
Age/years				0.556	0.458
>30	21	27.6	30.0±40.4
≤ 30	55	72.4	29.0±40.7
Marital status				3.406	0.069
Single	49	64.5	28.6±41.0
Coupled	27	35.5	25.9±39.8
Education level				16.089	0.000
Undergraduate or below	51	67.1	13.9±31.3
Above undergraduate	25	32.9	55.0±43.3
Annual income/yuan				8.104	0.006
>120 000	31	40.8	13.6±30.8
≤120 000	45	59.2	47.3±43.3
Body mass index/(kg/m²)				0.830	0.440
Normal (18.5-24.9)	13	17.1	28.8±38.1
Overweight (25.0-29.9)	41	53.9	29.5±43.4
Fat (≥30.0)	22	28.9	29.1±39.4
Sexual orientation				-	-
Heterosexual	75	98.7
Homosexual	1	1
Bisexual	0	0

Category	Number	Mean score	Range
No regret	47	0	0
Mild	7	17.5±6.5	0-25
Moderate	22	60.7±19.1	30-100
Total	76	27.6±38.2	0-100

	Anxiety	Depression	VPI	IIEF
DRS	0.760^#	0.471^#	-0.348^#	0.020
Anxiety	-	0.324^#	-0.267^#	0.137
Depression	-	-	-0.367^#	0.110
VPI	-	-	-	-0.152