阴茎异常勃起诊治21例报告

目的探讨阴茎异常勃起的诊治方法、病理及预后。方法阴茎异常勃起患者21例，经彩色多普勒超声海绵体血流成像、血气分析及穿刺活检术确诊后采用保守治疗、分流术及阴茎切除术等。结果低流量型阴茎异常勃起19例。勃起时间≤12h者8例。病理示海绵体间质轻度水肿，保守治疗后阴茎疲软，随访勃起功能正常；勃起时间13～24h者4例，其中轻度间质水肿1例、中重度3倒，行阴茎头-阴茎海绵体分流术后症状消失，随访3例勃起功能正常,1例发生轻度勃起功能障碍（ED）；勃起时间25～48h者2例。病理镜下示海绵体平滑肌局灶性坏死及纤维样细胞,术后2侧均复发。其中1例扩大内瘘口后勃起消失，随访性功能无减退。另1例白血病引起者综合化疗后症状缓解，随访发生中度ED；勃起时间49～72h者3例。病理镜下示海绵体平滑肌广泛坏死、大量纤维样细胞及血栓形成。行大隐静脉－海绵体分流术后勃起消失。随访2例发生重度ED，1例术后2周因肺、脑梗死死亡；2例阴茎转移癌分别于术后12、18个月死亡。高流量型阴茎异常勃起2例，术后随访性功能正常。结论海绵体损伤程度与异常勃起时间紧密相关。应尽早采取治疗措施。同时治疗愿发病有助于提高疗效、改善预后。

Diagnosis and treatment of priapism(report of 21 cases)

Objective To discuss the diagnosis, therapy and pathogenic factors involved in pria-pism. Methods Twenty-one patients with priapism were retrospectively analyzed. The priapism was diagnosed by cavernous blood gas analysis, color Doppler ultrasonography and biopsy. The managements of those cases included injection into the corpus cavernosum of alpha adrenergic receptor agonists, aspiration, surgical shunts, and phallectomy. Results Nineteen cases were low-flow priapism, among them, 8 cases were in the early stage of priapism(less than 12 h) that showed slight trabecular edema pathologically and recovered after conservative treatment with preservation of erectile function (EF). Four cases persisted from 13 h to 24 h showed slight or moderate trabecular edema and achieved detumescence after glandular-cavernosal shunting, after follow-up of 3 months to 2 years, 3 of them remained normal EF and one experienced mild ED. Two cases with the prolonged duration(25 -48 h) showed local trabecular smooth muscle cell(SMC) necrosis and transformation into fibroblast-like cells, 1 of them recurred after shunting, but obtained complete remission with normal EF by creating a broader fistulae, the other relapsed three times in a month, but achieved detumescence with moderate ED after chemotherapy and conservative treatment. Three cases lasted from 49 h to 72 h achieved detumescence gradually after Cavernoso-Saphenous vein shunt, but 2 of them suffered from severed ED due to corpus cavernosum fibrosis, 1 died of pulmonary and cerebral embolism, the other 2 cases caused by penis carcinoma that persisted more than 72 h survived 1 and 1. 5 years after phallecto-my. Two cases of high-flow priapism had no significant change of erection after surgery. Conclusions Early treatment is required for priapism. The ischemia time is highly related to its outcome.