糖尿病性勃起功能障碍研究进展

勃起功能障碍是糖尿病常见并发症。糖尿病性勃起功能障碍发病率为20%~75%。糖尿病引起的血管、神经病变,肌肉组织的改变导致勃起功能障碍。控制血糖、血压和血脂是糖尿病性勃起功能障碍治疗的基础。半数的糖尿病性勃起功能障碍患者用磷酸二酯酶-5抑制剂治疗有效,海绵体内注射血管活性剂有效率大于90%,阴茎假体植入手术适用于经其他治疗效果不满意的各种勃起功能障碍患者。     

氧化应激与糖尿病性勃起功能障碍

勃起功能障碍(ED)是糖尿病进程中常见的并发症,其发病机制十分复杂,涉及到神经及神经递质、血管及血管活性物质、内分泌、代谢等多方面因素。糖尿病状态下,自由基增多引发氧化应激损伤,影响到糖尿病性ED发生发展中的各个环节。本文针对氧化应激在糖尿病性勃起功能障碍进程中的作用作一综述。     

糖尿病患者勃起功能障碍的流行病学调查

目的：研究勃起功能障碍在糖尿病人群中的分布及其危险因子，探讨勃起功能障碍（ED）的病因、发病机制和和病理生理。方法：采用国际勃起功能评分－5（IIEF－5）作为判断有无勃起功能障碍的标准，共调查了187例分泌门诊糖尿病成年已婚男性，比较该人群中暴露于不同危险因子下勃起功能的变化。并同时对可能引起ED患病率增加的多个危险因子分别进行研究。结果：发病与糖尿病患者的年龄，吸烟，文化教育水平，病程、血糖控制水平以及是否合并神经，视网膜病变和糖尿病足综合征等因素密切相关，与糖尿病患者的糖尿病分型，治疗方案、BMI指数，既往有无高血压病，冠心病史，饮酒，是否合并轻度肾功能损害等因素无显著性关联。结论：糖尿病人应该注意控制血糖水平，戒烟，加强对糖尿病了解及配合医生系统有效治疗减少并发症，以达到降低ED发病水平及提高生活质量的目的。     

糖尿病性勃起功能障碍的发病机制及治疗进展

勃起功能障碍是糖尿病的常见并发症之一 ,由糖尿病引起的血管组织、神经及神经递质以及内分泌因素的改变导致 ,针对发病机制有多种治疗手段 ,包括PDE5抑制剂、胰岛素、雄激素、药物联合治疗和外科治疗、基因治疗等。     

神经功能的改善在糖尿病性勃起障碍治疗中的作用

目的探讨改善神经功能在糖尿病性勃起障碍(ED)治疗中的作用。方法:将70名糖尿病性ED患者随机分为Ⅰ组(空白对照组)、Ⅱ组(给予甲钴胺、西洛他唑和十一酸睾酮口服治疗),采用随机、对照试验方法,观察患者神经传导速度和勃起功能的变化。结果:治疗3个月后,Ⅱ组患者腓总神经和胫神经的传导速度较治疗前及对照组患者明显增快,神经功能明显改善(P<0.01),患者的国际勃起功能指数(IIEF)评分明显上升,勃起功能较治疗前及对照组明显改善(与治疗前相比P<0.01,与对照组相比P<0.05),IIEF评分与腓总神经和胫神经的传导速度呈明显正相关。结论:改善神经功能可明显改善糖尿病性ED患者的勃起功能,在治疗ED患者时,应关注患者神经功能的改善。     

糖尿病性勃起功能障碍大鼠阴茎海绵体组织中神经生长因子的表达及其治疗作用的研究

目的:本研究通过检测糖尿病性勃起功能障碍(ED)大鼠阴茎组织中神经生长因子(NGF)表达,并使用hNGF进行治疗,以探讨糖尿病性ED发病机制及NGF治疗作用的机制。方法:成年雄性SD大鼠60只,随机取50只大鼠用于制作糖尿病模型,饲养8周后,取正常组和糖尿病组大鼠阴茎海绵体组织,采用RT-PCR和W estern印迹法检测NGF的mRNA及蛋白水平。从造模成功的糖尿病大鼠中筛选出有ED大鼠,把所有大鼠分为5组:正常组、糖尿病性ED组、糖尿病性ED单用NGF组(NGF组)、糖尿病性ED单用胰岛素组(R I组)、糖尿病性ED联合应用NGF和胰岛素组(NGF+R I组,胰岛素通过颈部皮下注射给药,NGF通过腹腔内注射给药),8周后测海绵体内压(ICP),并取所有大鼠阴茎海绵体组织用免疫组化法观察nNOS神经纤维的变化。结果:与正常组相比,糖尿病性ED组大鼠阴茎海绵体组织中NGF的mRNA表达增加,蛋白含量增加。与糖尿病性ED组相比,NGF组、R I组、NGF+R I组ICP水平显著升高(P<0.05);NGF组、R I组、NGF+R I组阴茎组织中nNOS神经纤维水平显著升高(P<0.05)。结论:糖尿病晚期勃起神经出现损伤并发生ED,推测可能与NGF分泌增加的幅度小于高血糖状态对勃起神经的损伤程度有关,也可能与NGF与其相应受体结合转运能力损害有关,给予外源性NGF可能有助于糖尿病性ED局部神经病变减轻和勃起功能改善。提示NGF的异常在糖尿病性ED的发病及治疗中可能具有重要作用。     

褪黑素抗氧化治疗糖尿病大鼠阴茎勃起功能障碍的研究

目的 观察褪黑素对糖尿病大鼠阴茎勃起功能的影响,探讨氧化应激在糖尿病性勃起功能障碍发病机制中的作用.方法 一次性腹腔注射STZ建立糖尿病大鼠模型,随机分为糖尿病组、褪黑素(MT)治疗组以及对照组.8周后通过电刺激各组大鼠勃起神经来检测海绵体内压,评价勃起功能;采用硫代芭比妥酸法检测阴茎海绵体组织中丙二醛(MDA)含量,黄嘌呤氧化酶法测超氧化物氧化酶(SOD)活性;免疫组化染色半定量分析各组大鼠阴茎海绵体中平滑肌及内皮的含量.结果 与正常对照组相比,阴茎海绵体组织中MDA含量显著增加(P＜0.01),SOD活性降低(P＜0.05),最大海绵体内压(ICP)亦显著降低(P＜0.05);与糖尿病组相比,MT组大鼠海绵体MDA含量明显降低(P＜0.05),其SOD活性和ICP显著升高(P＜0.05);且其海绵体平滑肌及海绵窦内皮细胞含量明显提高.结论 MT可通过改善组织中氧化应激水平,促进阴茎海绵体平滑肌和内皮组织修复,提高勃起功能;抗氧化治疗可能为糖尿病性勃起功能障碍的防治提供新的策略.     

糖尿病性勃起功能障碍的血管因素

糖尿病性勃起功能障碍(DED)是一种由多因素引起的综合病症,其中血管内皮系统的损害起着重要作用。在糖尿病发展过程中,一些血管舒缩因子和生长因子有着显著的改变。这些改变与DED的发生存在明显的相关性。     

细胞因子治疗勃起功能障碍的研究进展

细胞因子与勃起功能障碍(ED)密切相关。研究发现,4类相关细胞因子和ED发生与治疗有关。促进血管再生的细胞因子可以改善血管内皮功能,促进内皮再生从而改善勃起功能;促进神经再生的细胞因子通过保护海绵体神经改善勃起功能;保护平滑肌功能的细胞因子通过促进平滑肌表达,抑制阴茎纤维化改善勃起功能;炎症相关的细胞因子通过作用于平滑肌上相应受体松弛平滑肌改善勃起功能。与5型磷酸二酯酶(PDE-5)抑制剂相比,细胞因子治疗ED更有针对性。但是,目前的实验模型大多数为大鼠且缺乏大样本的研究,限制了细胞因子进一步应用于临床。所以,虽然血管内皮生长因子(VEGF)、胰岛素样生长因子1(IGF-1)、脑源性神经营养因子(BDNF)、神经生长因子(NGF)等可以显著改善ED动物的勃起功能,但是需要大型动物实验和大样本的实验进一步证实其治疗效果和安全性。     

静脉性勃起功能障碍诊疗的研究进展

静脉性勃起功能障碍(VED)在勃起功能障碍(ED)患者中占大部分,在临床中常常合并其他类型ED而被忽视,生活方式、精神因素、心血管疾病、糖尿病等均可导致VED。如今对静脉性勃起功能障碍的机制研究进一步明确,所以在其诊疗方面就有了许多创新和发展。本文将静脉性ED现有诊疗研究进行综述,为大家对静脉性ED的诊断和治疗提供参考。     

Anatomy of the Sacral Roots and the Pelvic Splanchnic Nerves in Women Using the LANN Technique

AIMS: To report on our anatomic and electrophysiologic findings about the sacral nerve roots and the pelvic splanchnic nerves during laparoscopic pelvic surgery. METHODS: The pelvic splanchnic nerves and the sacral nerve roots were dissected in 336 consecutive patients undergoing laparoscopy for pelvic pain syndrome or gynecologic diseases. Intraoperative assessment of the functionality of the exposed nerves was performed using the LAparoscopic Neuro-Navigation (LANN) technique. RESULTS: Dissection of the sacral roots and the splanchnic pelvic nerves lateral to the sacral hypogastric fascia was feasible without any complications in all patients in this series. The mean surgical time was 16 minutes per side. The pelvic splanchnic nerves could be divided anatomically and functionally into vesical and rectal nerve fibers. CONCLUSIONS: Laparoscopy in combination with the LANN technique not only permits an intraoperative functional mapping of the pelvic motoric autonomous nerves but also a differentiation between the vesical and rectal nerves and between the efferent and afferent pelvic nerves.     

Regulation of the bladder neck closure by lumbar splanchnic nerves at ejaculation in the dog

To clarify the role of canine thoracolumbar splanchnic nerves for bladder neck closure during ejaculation, these nerves of adult male mongrel dogs were exposed under anesthesia using ketamine hydrochloride and pentobarbital, and electrical stimulation and anatomical dissection studies were performed. Bladder neck closure by the stimulation of each sympathetic nerve was monitored with a 10 Fr silicon catheter equipped with pressure-sensitive rubber balloon placed at the bladder neck. The dissection study revealed that canine thoracolumbar splanchnic nerves consisted of two nerve groups: one branching from the sympathetic trunks at thoracic and L1 ganglia, reaching caudal mesenteric plexus (CMP) through the anterior wall of the aorta, the other branching from the sympathetic trunks at level L2–L5 ganglia, reaching CMP through the posterior side of the bilateral spermatic arteries. The former were designated intermesenteric splanchnic nerves, the latter lumbar splanchnic nerves. No bladder neck closure was observed by electrical stimulation of the distal end of severed intermesenteric splanchnic nerves or of the sympathetic trunks at the lumbopelvic level among 10 dogs examined. At least one lumbar splanchnic nerve generated the closure in all 10 dogs and generally, a few lumbar splanchnic nerves, generated the closure. The results indicate that bladder neck closure during ejaculation is generated by lumbar splanchnic nerves regardless of their branching levels from lumbar sympathetic ganglia, but not by either intermesenteric splanchnic nerves or pelvic sympathetic trunks. © 1993 Wiley-Liss, Inc.     

Slow-transit constipation after radical hysterectomy type III

Background: This study investigated ways to reduce the rate of slow-transit constipation after radical hysterectomy type III. Methods: A prospective study was conducted involving 59 consecutive patients with cervical cancer stage IB1–IIIA at high risk for parametrial or lymph node involvement who were treated between May 1996 and March 1999 by laparoscopically assisted radical vaginal hysterectomy type III. Results: During laparoscopic transection of the cardinal ligament, particular attention was focused on conservation of the pelvic splanchnic nerves. After vaginal removal of the uterus, a vaginal sacrocolporectopexy was performed transvaginally. Nerve preservation and pexy of the rectum allowed a significant reduction of postoperative constipation, as compared with classic radical hysterectomy without conservation of the splanchnic pelvic nerves and without sacrocolporectopexy. Conclusion: Refinements in the preparation of the parasympathetic nerves during radical pelvic surgery and refixation of the terminal rectum helps to prevent postoperative constipation.     

Anatomical studies of the autonomic nervous system in the human pelvis by the whole-mount staining method: left-right communicating nerves between bilateral pelvic plexuses

PURPOSE: Some recent neurophysiological studies have suggested cross-innervation of pelvic genitourinary organs by extrinsic left-right communicating nerves. However, no definite course for these nerves has been clearly determined macroanatomically in humans. In the present study we extensively investigated the adult human pelvis to elucidate their courses by the whole-mount staining method. MATERIALS AND METHODS: A total of 6 male human specimens that had been subjected to pathological dissection were examined by means of an acetylcholinesterase whole-mount staining method. A map of nerve pathways was made by composite photomicrography. Histologically, nerves dissected accurately under a dissecting microscope were stained with both Klüver-Barrera stain and the Bodian method. RESULTS: The communicating nerves between bilateral pelvic plexuses were observed at the back of the rectum and in the rectoprostatic space. The former were composed of nothing but myelinated fibers in the same way as the pelvic splanchnic nerve. By contrast, the latter were composed of unmyelinated fibers with a few myelinated fibers. The pelvic plexus could be divided into three portions, anterosuperior, anteroposterior and inferior areas, by ganglion type. Morphologically, fiber components differed among those three portions. CONCLUSION: The communicating nerves at the back of the rectum seemed to be predominantly parasympathetic communicantes between bilateral pelvic splanchnic nerves rather than pelvic plexuses. These nerves may be involved in postoperative voiding function in the case of pelvic surgery with hemilateral nerve preservation. The function of the pelvic plexus seemed to be heterogeneous in each portion according to our morphological results.     

直肠癌根治术中保留骨盆自主神经的神经解剖学基础及临床意义

目的　探讨直肠癌根治术中保留神经的解剖学基础。　方法　解剖 6例完整尸体标本(男 4例 ,女 2例 )和 4例直肠及盆腔未受破坏的矢状半骨盆标本 ,观察骨盆神经组成及走行。　结果　显露下腹神经干 ,确定其在第 5腰椎处分为左、右下腹神经。其特点是较为粗大 ,位置固定 ,在腹主动脉分叉处易找到 ,呈网状联系 ,质地较实 ,为灰白色 ,与腹主动脉较近。分叉后左右下腹神经还有较粗大分支。骨盆内脏神经在大体标本上较难辨认 ,在矢状半骨盆标本中见到发自骶前孔 2～ 4的骨盆内脏神经 ,该神经较纤细 ,在侧韧带处呈丛状的细小纤维。　结论　保留下腹神经临床上较易完成。保留骨盆内脏神经则须细心操作 ,预保留神经的一侧在侧韧带水平的手术操作应尽量贴近直肠进行。     

射精时泄精和膀胱颈关闭的控制机理

通过对犬胸腰段内脏神经的电刺激来验证射精时交感神经信号的传导径路。该信号在射精时，使精液从射精管道泄出并使膀胱颈关闭。在大的胸腰段内脏神经中有两组神经纤维，一组从胸段和腰１的交感神经干发出，下行到主动脉前壁上的肠系膜尾丛（相当于人类的肠系膜下神经丛和腹下丛的上部）；另一组从腰段（腰１～腰５）的交感神经干发出，延伸到主动脉前壁，但不覆盖精索动脉，称为腰部内脏神经。用电刺激第１组神经，既不引起泄精，也不引起膀胱颈关闭；而刺激第２组神经（腰部内脏神经）的每一分支，都可引起泄精和膀胱颈关闭，当腹下神经被切断后，上述两种现象就不再发生。经过一段时间后，由于腰骶交感神经干和精索神经的代偿作用可恢复泄精，但膀胱颈关闭得不到代偿。因此，切断腹下神经可导致大的逆行射精。     

直肠癌治疗术后勃起功能障碍的发病机制

直肠癌是常见的消化道恶性肿瘤之一,近年来发病率逐年上升。目前治疗方法包括手术治疗、放化疗以及多种方式联合的综合治疗。性功能障碍尤其是勃起功能障碍(ED)是男性直肠癌治疗术后最常见的并发症之一,严重降低了患者术后的生活质量,既往公认其主要原因是损伤了盆腔自主神经。近年的研究发现其发病机制不仅如此,而是一个复杂的病理生理过程,包括神经、血管、心理因素等。现就直肠癌治疗术后ED的发病机制作一综述,为临床上预防和治疗术后ED提供理论依据,从而降低其发生率,提高患者的生活质量。     

Lumbosacral sympathetic trunk as a compensatory pathway for seminal emission after bilateral hypogastric nerve transections in the dog

Seminal emission after transection of canine bilateral hypogastric nerves was investigated. Stimulation of severed hypogastric nerves caused full volume seminal emission (greater than four drops) in all six dogs examined. In contrast, stimulation of sympathetic trunks of other six dogs at the level of caudal mesenteric artery caused no emission in three dogs and a limited volume of seminal emission (less than one drop) by pressing the ampulla in the remaining. When hypogastric nerves were transected one month prior to the experiment, however, stimulation of sympathetic trunks in the same manner caused full volume of seminal emission in all six dogs. Distal dissection of sympathetic trunks demonstrated nerve fibers to the seminal tract via the pelvic splanchnic nerves. The results indicate that the seminal tract receives at least two sympathetic pathways; one from hypogastric nerves and the other from lumbosacral sympathetic trunks, and that the latter compensatorily generates seminal emission after hypogastric nerve transection.     

从盆腔筋膜的外科解剖来理解直肠全系膜切除术的层次

目的探讨直肠系膜与盆腔筋膜和神经的关系，以明确直肠全系膜切除术合理的切除平面。方法对24具尸体的盆腔进行解剖。结果直肠周围的层次是连续的，可以分为2段3层，2段指耻骨联合至坐骨棘和坐骨棘至骶岬；3层分别为脏筋膜、膀胱腹下筋膜和壁筋膜。在膀胱腹下筋膜与脏筋膜之间存在盆丛及其膀胱、子宫神经分支，而在脏、壁筋膜之间存在腹下神经和盆内脏神经。结论直肠全系膜切除术的层次在直肠后方为脏、壁筋膜之间，而在直肠侧方实际上位于脏筋膜和膀胱腹下筋膜之间。侧后方的腹下神经、侧前方的盆丛及其分支是正确层次的标记。