阴茎异常勃起的诊断和治疗(附10例报告)  

Diagnosis and treatment of priapism (report of 10 cases)

作　　者：陈戈明[1] 赵伟平[1] 朱选文[1] 高文君[2] 蔡松良[1] 梁忠炎[1] 王康儿[2] 沈煜[1] 

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,杭州310003 [2]杭州市第二医院

出　　处：《中华泌尿外科杂志》2004年第11期765-767,共3页Chinese Journal of Urology

摘　　要：目的　分析不同病因 ,区分低流量型和高流量型阴茎异常勃起 ,提高急诊处理阴茎异常勃起的能力。　方法　 10例阴茎异常勃起患者年龄 2 2～ 6 4岁 ,平均 4 1岁。持续勃起时间 8～ 2 12h ,平均 2 1.2h。其中阴茎海绵体内注射前列腺素E、罂栗碱、酚妥拉明治疗勃起功能障碍致异常勃起1例 ,服用西地那非后性交勃起异常 1例 ,阴茎原发肉瘤 1例 ,膀胱癌转移至阴茎 1例 ,白血病 1例 ,有外伤史者 2例 ,不明诱因者 3例。对异常勃起分型 ,治疗及预后进行分析。　结果　 10例患者中 8例为低流量型 ,2例为高流量型。 8例低流量型患者中 ,4例经阴茎海绵体根部注射间羟胺 2～ 8mg ,必要时在阴茎头及阴茎海绵体根部置 9号针头灌注肝素化生理盐水对冲治愈 ,其中 1例发生勃起功能障碍 (ED) ;1例行阴茎海绵体与阴茎头血管分流术治愈。因白血病引起的阴茎异常勃起 1例 ,经化疗后治愈 ;阴茎肉瘤 1例 ,膀胱癌转移至阴茎 1例 ,预后均不佳。 2例高流量型患者中 1例行选择性阴部内动脉栓塞后治愈 ,1例行保守治疗出院 ,随访出现ED。　结论　详细的病史、阴茎海绵体血气分析、彩色多谱勒检查、阴部内动脉造影等是区分高流量型和低流量型阴茎异常勃起的重要方法。阴茎异常勃起如保守治疗无效 。Objective To ascertain the causes of priapism and to differentiate between the ischemic low-flow type and nonischemic high-flow type so as to improve the clinicians' ability for emergency treatment of priapism. Methods Ten cases of priapism were included.Their mean age was 41 years (range,22～64 years).The priapism lasted 8 to 212 h with a mean of 21.2 h.Of them 1 case had received prostaglandin E,papaverine and phentolamine injection into cavernous body of penis,which led to ED;1 had priapism when experiencing sexual intercourse after taking sildenafil;1 had primary sarcoma of the penis;1 had transitional cell carcinoma of bladder, which metastasized to the penis;1 had leukemia; 2 had traumatic history;and 3 had unknown causes.The types,causes,treatment and outcomes of priapism were analyzed. Results Of the 10 cases,8 were of ischemic low-flow type and 2 of nonischemic high-flow type. In the 8 cases of ischemic low-flow type priapism, 4 achieved detumescence after receiving metaraminol injection (2～8 mg) at the root of cavernous body,and perfusion of haparinized saline at glans and root of cavernous body of the penis by contrecoup if necessary (1 had ED).One case undergoing glandular-cavernosal shunting achieved detumescence with preservation of erectile function.One case with leukemia was cured after chemotherapy.One case suffered from penile sarcoma and the rest 1 from metastasis of transitional cell carcinoma; the prognoses of both were unfavorable.Of the 2 cases of high-flow type,1 achieved detumescence after selective embolization of internal pudendal artery;the other was discharged after conservative treatment,but experienced ED. Conclusions Blood gas analysis of cavernosal blood,color Doppler ultrasound,and internal pudendal arteriography are useful in differentiating the types of priapism.If conservative treatment fails to achieve detumescence of the penis,surgical treatment should be performed immediately for both types of priapism.

关 键 词：阴茎异常勃起 阴茎海绵体 治愈 患者 低流量 治疗 阴部 结论 能力 方法 

分 类 号：R697.2[医药卫生—泌尿科学]