选择性介入栓塞在不同分型静脉性勃起功能障碍中的应用研究  

Application of selective interventional embolization in different types of venous erectile dysfunction

作　　者：高庆强 李源芷 王彬 戴玉田 宋涛 Gao Qingqiang;Li Yuanzhi;Wang Bin;Dai Yutian;Song Tao(Department of Andrology,Drum Tower Hospital Affiliated to Medical College of Nanjing University,Nanjing 210008,China;Department of ICU,Drum Tower Hospital Affiliated to Medical College of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京鼓楼医院男科,南京210008 [2]南京鼓楼医院重症医学科,南京210008

出　　处：《国际泌尿系统杂志》2025年第1期103-106,共4页International Journal of Urology and Nephrology

基　　金：南京鼓楼医院临床研究专项基金(2023-LCYJ-PY-41)。

摘　　要：目的探讨选择性介入栓塞在不同分型静脉性勃起功能障碍中的应用价值。方法选取2021年1月至2023年1月在本院经阴茎海绵体注射试验(ICI)联合彩色多普勒双功能超声检查怀疑为静脉性勃起功能障碍(VED)的患者作为研究对象,通过海绵体造影与测压(DICC)最终确诊57例VED患者,根据不同的维持灌注速度(FTM)和海绵体压力衰退值(PD)将患者分为:轻度VED组(24例,1.0 mL/s≤FTM<1.5 mL/s或40 mmHg≤PD<70 mmHg,影像学角度观察,该型患者有9例未发现明显静脉漏)、中度VED组(18例,1.5 mL/s≤FTM<2.0 mL/s或70 mmHg≤PD<100 mmHg,检查中摄片均发现明显的静脉漏)、重度VED组(15例,FTM≥2.0 mL/s或PD≥100 mmHg,检查中摄片均发现明显的静脉漏)。所有患者在排除禁忌证后,行阴茎海绵体静脉介入栓塞治疗,对比分析治疗前、后三组患者的临床症状、国际勃起功能指数评分(IIEF-5)的变化。结果轻度VED组的IIEF-5评分均>14分,中度、重度VED组的IIEF-5评分为0~11分。行介入栓塞治疗后,轻度VED组中有8例临床效果不理想,继续采用5型磷酸二酯酶抑制剂治疗后获得较好的效果;中度VED组有6例临床效果不满意,给予5型磷酸二酯酶抑制剂治疗后亦无明显改善;重度VED组治疗无效。介入栓塞治疗的所有患者术毕同时行海绵体造影,均显示栓塞成功,海绵体回流静脉栓塞确切,而且患者在3~6个月后复查盆腔X片显示栓塞胶在位良好。轻、中度VED组患者的介入栓塞治疗效果优于重度VED组(均P<0.05)。结论利用DICC临床指导VED分型,选择性介入栓塞对于轻、中度VED有良好的治疗效果,可改善患者勃起功能,但对于重度VED效果不佳。Objective To explore the application value of selective interventional embolization in different types of venous erectile dysfunction.Methods Patients suspected of venous erectile dysfunction(VED)were selected from our hospital from January 2021 to January 2023 by means of penile cavernose injection test(ICI)combined with color doppler duplex ultrasonoply(CDDU).According to different flow to maintain(FTM)and cavernous pressure decay(PD),the patients were divided into:Mild VED group(24 cases,1.0 mL/s≤FTM<1.5 mL/s,40 mmHg≤PD<70 mmHg,9 cases of this type of patients did not find significant venous leakage from the imaging perspective),moderate VED group(18 cases,the manifestations were 1.5 mL/s≤FTM<2.0 mL/s,70 mmHg≤PD<100 mmHg,and obvious venous leakage was found in all the radiographs during examination)and severe VED group(15 cases,FTM was≥2.0 mL/s,PD was≥100 mmHg,and obvious venous leakage was found during the examination).After contraindications were excluded,all patients were treated with penile cavernous vein interventional embolization.Clinical symptoms and international erectile function index(IIEF-5)of three groups were analyzed before and after treatment.Results The IIEF-5 scores of mild VED group were all>14 points,and the IIEF-5 scores of moderate and severe VED group were 0-11 points.After interventional embolization,8 cases in mild VED group had unsatisfactory clinical results,and continued treatment with type 5 phosphodiesterase inhibitors achieved better results.There were 6 cases in the moderate VED group with unsatisfactory clinical results and no significant improvement after treatment with type 5 phosphodiesterase inhibitors.All patients with severe VED failed to receive treatment.Cavernography was performed at the same time in all patients after interventional embolization,which showed successful embolization and accurate cavernous return vein embolization.The effect of interventional embolization in mild and moderate VED group was better than that in severe VED group(all P<0.05).Con

关 键 词：勃起功能障碍 介入栓塞 阴茎海绵体动态测压及造影 

分 类 号：R698[医药卫生—泌尿科学]