阴茎背神经选择性切除术治疗原发性早泄的安全性和疗效  

The safety and efficacy of selective dorsal neurectomy for primary premature ejaculation

作　　者：杨俊武 邓昊 张春影[1] 初茂林[1] 曹伟[1] 齐玉琢 Yang Junwu;Deng Hao;Zhang Chunying;Chu Maolin;Cao Wei;Qi Yuzhuo(The Number 2 Department of Urology,the Second Affliated Hospital of Harbin Medical University,Harbin 150086,China;Department of Urology,First Affiliated Hospital of YangtzeU niversity,Jingzhou 434000,China)

机构地区：[1]哈尔滨医科大学附属第二医院泌外二科,哈尔滨150086 [2]长江大学附属第一医院泌尿外科,荆州434000

出　　处：《中华泌尿外科杂志》2024年第2期132-136,共5页Chinese Journal of Urology

摘　　要：目的探讨阴茎背神经选择性切除术治疗原发性早泄的安全性和有效性。方法回顾性分析2016年12月至2020年12月哈尔滨医科大学附属第二医院收治的47例原发性早泄患者的临床资料。所有患者均符合原发性早泄的临床特征。年龄(31.4±5.7)岁。病程(9.6±5.1)年。已婚29例(65.9%),未婚15例(34.1%)。国际勃起功能指数-5(IEF-5)评分(23.6±1.2)分。早泄诊断工具量表(PEDT)评分(15.2±2.7)分。射精控制能力评分(10.1±1.5)分。患者性生活满意度评分(2.3±1.7)分。性伴侣性生活满意度评分(2.3±1.3)分。夜间阴茎勃起试验(NPT):Ⅱ级硬度19例、IV级硬度28例。阴道内射精潜伏时间(IELT)(0.9±0.5)min。所有患者均接受阴茎背神经选择性切除术。距冠状沟0.6~0.8cm做环形切口,逐层切开皮肤、皮下组织。距冠状沟0.8~~1.5cm分离阴茎筋膜组织后将阴茎皮肤脱套至阴茎根部。在阴茎背深静脉、阴茎背动脉解层次的上面可见阴茎背神经,以阴茎背侧正中12点为中心向两侧分离显露阴茎背神经,至阴茎腹侧达尿道海绵体处,用丝线提起分离的阴茎背神经。根据神经分布均衡原则,在阴茎头3、9、12点各保留1支,保留3~4支阴茎背神经,如保留的阴茎背神经横径>1.5mm,继续向远端分离至接近阴茎头处,使保留的阴茎背神经横径<1.5mm。记录术中发现的阴茎背神经总数和保留数量。术后3.6、12、24个月随访IELT、射精控制能力评分、患者和性伴侣性生活满意度评分,以及术后并发症等指标。结果本研究47例手术均顺利完成。每例术中发现阴茎背神经总数为(9.8±1.6)支,其中14支1例,13支1例,12支6例,11支5例,10支8例,9支20例,8支5例,6支1例。44例获得随访,失访3例,随访时间(35.0±10.2)个月。术后3、6、12、24个月的IELT分别为(3.8±2.1)、(4.1±2.3)、(4.8±2.4)、(4.2±2.3)min,与术前比较差异均有统计学意义(P<0.05);射精控制能力评分分别为(5.9±2.9)、Objective To investigate the safety and efficacy of selective dorsal neurectomy(SDN)in the treatment of primary premature ejaculation(PPE).Methods The clinical data of 47 patients with PPE were retrospectively analyzed from December 2016 to December 2020.All patients were consistent with the clinical features of PPE.The age was(31.4±5.7)years old,the average duration of disease was(9.6±5.1)years,there were 29 married cases(65.9%)and 15 unmarried cases(34.1%),1IEF-5 score was(23.6±1.2),PEDT score was(15.2±2.7),ejaculation control ability score was(10.1±1.5),sexual intercourse satisfaction about patients was(2.3±1.7),sexual intercourse satisfaction about sexual partners was(2.3±1.3),19 cases were grade Ⅲ hardness and 28 cases were grade Ⅳ hardness for NPT,and IELT was(0.9±0.5)minute.These patients underwent SDN,and the surgeon made a circular incision at 0.6-O.8cm from the coronal sulcus.Then,the surgeon cut the skin and subcutaneous tissue layer by layer and separated the penile fascia tissue at a distance of about 0.8-1.5 cm from the coronal sulcus,and the dorsal penile nerve could be seen above the anatomical level.Centering on the 12 o'clock in the middle of the dorsal side of the penis,the surgeon separator forceps to reveal the dorsal penile nerve by separating both sides,reaching the urethral corpus cavernosum ventrally to the penis,and used silk thread to gently lift.Depending on the patient's specific condition,one nerve at each of the 3,9,and 12 o'clock of the penile head was preserved.In principle,approx.3-4 dorsal penile nerves were preserved,the rest of the dorsal penile nerves were severed and a length of 3-4cm was removed.If the retained dorsal penile nerve was>1.5 mm in transverse diameter,the surgeon continued to separate dorsal penile nerves distally until approaching the head of the penis.The total number and number of retained dorsal penile nerves were recorded.IELT,ejaculation control ability score,sexual intercourse satisfaction score,and postoperative complications were followed u

关 键 词：原发性早泄 阴茎背神经选择性切除术 阴道内射精潜伏时间 性生活满意度 射精控制能力 

分 类 号：R699.8[医药卫生—泌尿科学]