超选择性动脉栓塞与观察等待治疗高流量型阴茎异常勃起的疗效比较  

A comparison of the therapeutic efficacy of superselective arterial embolization and watchful waiting in high-flow priapism

作　　者：兰轲[1] 杨文博[1] 张晓威[1] 胡浩[1] 刘贵中 徐涛[1] 白文俊[1] Lan Ke;Yang Wenbo;Zhang Xiaowei;Hu Hao;Liu Guizhong;Xu Tao;Bai Wenjun(Department of Urology,Peking University People's Hospital,Beijing 100044,China;Department of Urology, Tianjin Jinnan Xianshuigu Hospital,Tianjin 300350,China)

机构地区：[1]北京大学人民医院泌尿外科,100044 [2]天津市津南区成水沽医院泌尿外科,300350

出　　处：《中华泌尿外科杂志》2019年第1期52-56,共5页Chinese Journal of Urology

摘　　要：目的 探讨超选择性动脉栓塞与观察等待治疗外伤所致的高流量型阴茎异常勃起(high-flow priapism,HFP)的疗效。 方法 回顾性分析2013年1月至2017年12月收治的6例外伤所致HFP患者的临床资料,年龄18~44岁,平均26.2岁。治疗前阴茎彩色多普勒超声测量瘘口周围低回声区长径为0.8~1.4 cm,平均1.14 cm。6例按治疗方式分为2组。手术组4例采用局麻,在放射介入下行阴部内动脉超选择性明胶海绵血管栓塞术,术后1年复查阴茎彩多普勒超声。观察等待组2例采用冰袋局部冷敷治疗,每小时1次,每次15 min,每日10次,治疗持续3周,然后随访观察患者的勃起硬度。根据患者主观感受将勃起硬度分为4个等级:Ⅰ级,阴茎胀大但不硬;Ⅱ级,阴茎有硬度,但不足以插入阴道;Ⅲ级,阴茎勃起可以插入阴道,但未达到完全坚挺;Ⅳ级,阴茎完全勃起并坚挺。观察等待组治疗后3周及1年复查阴茎彩色多普勒超声评估瘘口情况。随访中采用勃起功能国际指数5(IIEF-5)评估所有患者治疗后的勃起功能。 结果 手术组4例手术均顺利完成,术后未发生明显并发症,术后阴茎均疲软,未再出现阴茎异常勃起。6例的中位随访时间为21个月(5~50个月)。手术组术后1年复查阴茎彩色多普勒超声均未见明显异常,IIEF-5评分分别为25、24、24、23分,术后性功能均恢复。观察等待组2例均有Ⅱ~Ⅲ级的阴茎持续勃起,IIEF-5评分分别为21分和19分,治疗后3周及1年复查阴茎彩色多普勒超声仍提示动静脉瘘存在。 结论 与观察等待相比,超选择性动脉栓塞治疗HFP的疗效确切,患者术后性功能恢复较好。Objective Compare the efficacy of superselective arterial embolization with observation in the treatment of HFP caused by trauma.Methods From Jan, 2013 to Dec, 2017, 6 traumatic HFP patients were involved into the study, the age range from 18 to 44 years old, with an average age of 26.2 years. The fistula was measured by doppler ultrasonography before the treatment with its longest diameter, and which ranges from 0.8 to 1.4 cm, the average diameter is 1.14 cm. All patients are divided into two groups according to their treatment. Operation group: 4 patients underwent the pudendal artery superselective gelatin sponge vascular embolization. Control group: 2 cases were treated with local cold compressing under watchful waiting. In control group, patients are treated by local cold compress with ice bag for 3 weeks: 15 mins×10 times every day. The erectile hardness of the patients was observed and the fistula was evaluated by doppler ultrasonography 3 weeks later, and all the patients were reexamined by doppler ultrasonography 1 year later. The erectile hardness was divided into four grades according to the patient's subjective feelings: grade Ⅰ, the penis was enlarged but not rigid;grade Ⅱ, the penis had hardness, but not enough to insert into the vagina;grade Ⅲ, the penis could be inserted into the vagina, but not to achieve complete erection;grade Ⅳ, the penis fully erect and firm. The erectile function was evaluated with the International Index of Erectile Function-5(IIEF-5) after 1-year′s follow-up.Results 4 patients in the operation group were operated successfully without obvious complications after operation. Median follow-up time of all the patients was 21 months (5-50). In group operation, 4 cases of surgical patients did not have the recurrence of priapism. There was no obvious abnormality in the color doppler ultrasound of penis. The score of IIEF-5 was 25, 24, 24 and 23, respectively. Postoperative erectile function made a complete recovery. In group observation, 2 patients under watchful waiti

关 键 词：异常勃起 动脉栓塞 观察等待 性功能 随访 

分 类 号：R699.8[医药卫生—泌尿科学]