阴茎异常勃起15例诊疗体会

目的:提高阴茎异常勃起的诊治水平。方法:15例阴茎异常勃起患者,年龄20～66岁,平均46岁。持续勃起时间10～172h,平均28.4h。其中血管活性药物所致6例,膀胱癌转移至阴茎1例,白血病2例,有外伤史者3例,不明诱因者3例。对异常勃起分型,治疗及预后进行分析。结果:15例患者中,12例为低流量型,3例为高流量型。随访1～26个月,12例低流量型患者中,7例经阴茎海绵体根部注射间羟胺2～6mg,必要时在阴茎头及阴茎海绵体根部置9号针头灌注肝素化生理盐水对冲治愈,其中2例发生ED;2例行阴茎海绵体与阴茎头血管分流术治愈,其中1例术后出现ED。2例因白血病引起的阴茎异常勃起保守治疗后缓解,1例膀胱癌转移至阴茎,行阴茎全切。3例高流量型患者中1例行选择性阴部内动脉栓塞后治愈,未发生ED,2例行保守治疗出院,随访均出现ED。结论:详细的病史、海绵体血气分析和彩色双功能超声等检查有助于阴茎异常勃起正确及时的诊断。阴茎异常勃起如保守治疗无效,应立刻进行手术治疗。

Diagnosis and Treatment of Priapism:A Report of 15 Cases

Objective ： To improve the diagnosis and treatment of priapism. Methods ： We analyzed the types, causes, treatment and prognosis of 15 cases of priapism. The patients ranged in age from 20 to 66 （mean 46） years, their erection lasting 10-172 （mean 28.4） hours. Among them, 6 cases resulted from intaking vaso-active agents, 1 had transitional cell carcinoma of the bladder metastasized to the penis, 2 had leukemia, 3 had a traumatic history and the other 3 had unknown causes. Results： Of the total number, 12 fell into the ischemic low-flow type and 3 the non-ischemic high-flow type. Follow-up lasted 1-26 months. In the 12 cases of the ische- mic low-flow type, 7 were cured by 2-6 mg metaraminol injection at the root of the cavernous body and, when necessary, the perfusion of heparinized saline at the glans and the root of the cavernous body of the penis, and 2 achieved detumescence after glandular cavernosal shunting. The 2 cases caused by leukemia and 1 by metastasis of transitional cell carcinoma underwent peneetomy, but with unfavorable prognosis. Of the 3 high-flow type cases, 1 was cured by selective embolization of the internal pudendal artery and the other 2 discharged after conservative treatment, but developed ED on follow-up. Conclusion： Cavernous blood gas analysis and color duplex uhrasonography are helpful to the accurate and timely diagnosis of priapism. Cavernosal decompression and intracavernosal injection of aramine can be applied to most of the patients, ff conservative treatment fails to achieve detumescence of the penis, surgery should be performed immediately for beth types of priapism.