T型分流术治疗缺血性阴茎异常勃起的体会(附9例报告及文献复习)  

Our experience of T-shaped shunt for the treatment of ischemic priapism:9 cases report and a review of literatures

作　　者：汤育新[1] 谭正昱 周骏[1] 甘宇[1] 彭东毅[1] 阳建福[1] 王勇[1] 

机构地区：[1]中南大学湘雅三医院泌尿外科,长沙410013

出　　处：《中国男科学杂志》2016年第3期42-44,共3页Chinese Journal of Andrology

摘　　要：目的 探讨T型分流术治疗缺血性异常勃起的有效性.方法 回顾性分析9例缺血性阴茎异常勃起患者的诊治,所有患者术前完善阴茎及盆腔MRI,保守治疗无效后,予以T型分流＋肝素盐水冲洗术治疗.术中同时取海绵体或白膜组织行病检.结果 通过术前MRI结合术中病检的方法 ,确诊肿瘤所致异常勃起患者2例,其中1例为会阴部神经内分泌癌侵犯阴茎海绵体,出院后3个月死亡;1例为阴茎上皮样癌,行阴茎部分切除术.除2例肿瘤患者外,7例患者均于术后24h内勃起消退.术后随访6～18个月,2例患者保留勃起功能,5例患者出现勃起功能障碍,1例死亡,l例失访.结论 MRI对于阴茎异常勃起具有一定的临床价值,建议术前完善阴茎及盆腔MRI检查;T型术式简单并疗效理想,但对于肿瘤所致的阴茎异常勃起患者并不适用;术中对海绵体或白膜组织行病理活检,可发现偶发肿瘤,避免误诊.Objoetive To explore the efficacy of T-shaped shunt operation in the treatment of ischemic priapism. Methods Clinical data of 9 patients with ischemic priapism were retrospectively analyzed. All patients received preopetative MRI examination. T-shaped shunt operation and heparin saline flushing were performed for the patients after failure of conservative therapy. A wedge biopsy of corpus cavernosum were done during the operation for pathological diagnosis. Results 2 patients were diagnosed as malignant priapism by the method of the combination of MRI and pathological examination, one died of perineal neuroendocrine carcinoma and he refused to receive further treatment and died 3 months later; the other was caused by penile epithelioid sarcoma and then accepted partial resection of penis; Other 7 patients accepted the T-shaped shunt surgery, and had satisfactory outcome in 24 h. During 6-12 months follow-up, 2 cases preserved erectile function, 5 cases developed erectile dysfunction, 1 case died and 1 lost contact. Conclusion MR/shows clinical value in the management of ischemic priapism. Although T-shaped shunt operation has some advantages such as simple operation, less complications and satisfactory efficacy, it is still not suitable for treatment of tumor-caused ischemic priapism. A wedge biopsy of corpus cavernosum during operation is helpful to confirm malignant priapism.

关 键 词：阴茎异常勃起 磁共振成像 肿瘤 

分 类 号：R698.1[医药卫生—泌尿科学]