陰核釋出術

Metoidioplasty 陰核釋出術

涂懿美譯

陰核釋出術是我最常替女變男變性者所作的生殖器手術。在這個手術中，陰核周圍的皮膚被移除，陰核從恥骨鬆開，看起來會較長。陰蒂頭看起來會好像被割過包皮似的，手術的結果就是一個看來正常但是非常小的陰莖。

The most common genital operation that I perform for my FTM patients is a Metoidioplasty. In this operation, the surrounding skin of the clitoris is removed and it is released from the pubis to give the appearance of more length. The glans will appear circumcised in most patients. The final result is a normal appearing, but very small, penis.

This is a very favorable result. Actual result will depend on various factors as described below.

結果很令人滿意。不過真正的結果會因為不同的因素而改變，以下略述。

這個手術的結果很大一部份要看病人吸收睪丸素之後陰核長大到什麼程度而定。此時也可以同時延長尿道，或者下次手術再做，以便讓病人可以站立小便。延長尿道先要完全移除陰道。那些較瘦或是接近標準體重的病人接受陰核釋出術的結果最好，大部分患者都可以透過移除陰阜的皮膚和脂肪，並且將皮膚向上拉，以改善最後的結果。陰核釋出術會在陰毛附近留下一道彎疤，通常要等到第二階段以永久的人工睪丸取代擴張器時才會進一步處理。

The outcome is largely dependent upon how much enlargement of the clitoris has occurred with Testosterone. Urethral lengthening can also be done at the same time, or at a later time,to allow the patient to stand to urinate. Urethral lengthening requires complete removal of the vagina. The best results from the metoidioplasty are in patients who are thin or near their ideal body weight. In most patients, removal of the skin and fat of the mons pubis and pulling the skin upwards will improve the result. This will leave a curvilinear scar in the pubic hair and is usually done as a second stage when the expanders are replaced with a permanent testicular prosthesis.

陰核釋出術最大的優點在於它沒有侵略性，可以維持陰核的敏感度，而且沒有明顯的手術疤痕。如果患者需要，將來還可以再做生殖器手術。然而，陰核釋出所形成的陰莖看起來不像成人男性的陰莖尺寸，大小也不夠進行陰道性交。陰囊（陰囊整型）是在陰核釋出術的同時完成，人工睪丸可以同時植入，也可以下次再做。因為預留給人工睪丸的空間有限，我通常會先在新陰囊內放兩個組織擴張器，也就是放進兩個可以膨脹的氣球，然後病人到家之後可以慢慢將它們充氣，以擴張陰囊袋。三至六個月後，人工睪丸就可以被放進已經擴張的陰囊袋中，而問題會比較少。雖然陰核釋出術需要兩次手術，但是結果通常較好。第二次手術不需要住院，患者可以在當天回家。放進兩個人工睪丸應該無害，因為可能後來會需要把其中之一放低一些。如果做了尿道延長手術，就需要等三個月才能放進人工睪丸或擴張器。

The principal advantage of the metaoidioplasty is that it is noninvasive, maintains the sensitivity of the clitoris, and does not create apparent surgical scars. Furthermore, it does not prevent future genital surgery from being done at a later time should one decide. The penis will not, however, appear adult in size, and it is not large enough for vaginal intercourse. Formation of the scrotum (scrotoplasty) is done during the metaoidioplasty. Should you desire, prostheses for testicles could be placed at this time or at later date. Since there is frequently only limited space for these prostheses, I will often place two tissue expanders in the new scrotum. These are inflatable balloons placed in the scrotum, and then slowly inflated, at home, to expand the scrotal sack. Three to six months later, the permanent prosthesis can be placed in the expanded scrotum, with fewer problems. Although this method requires two operations, the end results are frequently better. The secondary procedure is an outpatient operation and the patient can return home the same day. There is probably no harm in placing two testicular prostheses, understanding that it may be necessary to lower one at a later time. If urethral lengthening is done, one must wait three months to have expanders or prosthesis placed.

術後照片（資料來源：Loren Cameron）

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