高血流量性阴茎异常勃起10例临床诊分析

目的 探讨外伤后阴茎异常勃起的诊治方法 及其预后.方法 外伤后阴茎异常勃10例,年龄26～42岁.平均32岁;阴茎无痛持续性勃起＞4 h,呈半勃起状态.给予性刺激后硬度增强;海绵体血气分析呈动脉血样特征.彩超发现一侧阴茎海绵体动脉较对侧呈局限性扩张,最宽处约0.8 cm,血流速度增快,探及低速高阻动脉频谱,未发现双侧海绵体动脉扩张,诊断为阴茎海绵体动脉瘘;经保守治疗无效后再行超选择性阴部内动脉造影和栓塞治疗术,有2例存在双侧海绵体动脉瘘.结果 经介入治疗后异常勃起的阴茎逐渐恢复痿软悬垂状,24～48h完全变软,2～4周后逐渐有晨勃,3～6月后恢复性交,勃起硬度与术前无明显改变,Rigiscan测定和阴茎勃起多参数定量分析均正常;随访1～3 a,无硬结发生,勃起后阴茎无明显偏曲和疼痛,能够满意完成性生活,射精后能够完全疲软,有2例性生活持续时间变短,性交频率减少.结论 根据典型病史、体征和海绵体血气分析可初步诊断,彩色多普勒超声及阴茎海绵体动脉血管造影检查有极高的诊断价值,选用可吸收性物质进行超选择性阴部内动脉栓塞术是目前治疗本病的最佳方案,安全有效,远期预后良好.

The Clinical Analysis of High-flow Priapism in 10 Cases

Objective To investigate the diagnosis and treatment of priapism after injury.Methods Ten cases of priapism after injury(aged 26 to 42 years,mean 32 years)were included.Their symptoms were described as painless penis persistent erection>4 h,incompletely but constantly rigid of the penis which was able to increase rigidity with sexual stimulation.Blood taken from the cavernosa showed an arterial blood sample in all the cases.Perineal color Doppler ultrasound findings included the penis artery was limited expansion compared with the contralateral side and blood flow velocity increased,and took out the arterial spectrum with low speed and high impedance,a maximum width of about 0.8 cm,found dilatation of bilateral cavernous arteries,the initial diagnosis was high blood-flow priapism.But penis angiography examination revealed there were bilateral cavernous arteries-sinus-like gap fistula in 2 cases.Results After embolization,the priapism was softened gradually.In all cases,24～48h soft drape-shaped recovery,there was growing morning erection after 2 to 4 weeks,and sexual life was recovered slowly after 3 to 6 months,erection hardness had no significant changes with preoperative.Rigiscan measure was normal.Regular follow-up was 1 to 3 years.Erected penis had no significant deviation and pain,fine hardness,satisfactory completion of sexual life after erections,but the duration of sexual life was shorten and frequency of sexual intercourse was reduced in 2 cases.Conclusions According to the typical history,physical examination and cavernous blood gas analysis,the priapism can be diagnosed initially,Color Doppler ultrasound and penile cavernous artery angiography have high diagnostic value.They can not only further confirm the diagnosis,but also determine the site of arterial fistula which artery embolization.Used of absorbable material to make super-selective pudendal artery embolization is currently the best option for the treatment of this disease,which is safe,effective and has good long-term prognosis.