阴茎头海绵体分流术治疗顽固性缺血性阴茎异常勃起15例临床分析

目的回顾性评价阴茎头海绵体分流术（Winter手术）治疗顽固性缺血性阴茎异常勃起的有效性及随访结果。方法 15例经保守处理无效的顽固性阴茎异常勃起患者,局部麻醉后,先用尖刀在一侧阴茎头部直插入海绵体内,旋转90°后再呈十字切开。经创口插入21G针头,反复肝素盐水冲洗,直至阴茎疲软。若一侧分流效果不佳,则同样方法处理对侧。术后常规静滴低分子右旋糖苷1周,出院后继续口服阿司匹林1个月。结果手术后绝大部分患者阴茎恢复疲软。2例患者双侧分流术后分别在24h及28h后,又再发异常勃起,有效率87.5%。除7例急性粒细胞性白血病患者需要接受专科治疗外,其余患者7-10d后顺利出院。结论阴茎头海绵体分流术可以有效地缓解顽固性缺血性阴茎异常勃起,术后随访部分患者可以维持较为满意的勃起功能。

Winter surgery for refractory ischemic priapism with a report of 15 cases

Objective To retrospectively evaluate the efficacy and followup of Winter surgery for refractory ischemic priapism.Methods From June 2003 to August 2009, 15 patients with priapism who were refractory to conservative management were treated with Winter surgery. Average age was 36.3 years （range 22 to 58 years）. 2 patients had a history of papaverine injection at short period before. 7 patients had identified AGL immediately at hospital stay. The others had no significant precipitating factors. The average duration was 13.8h （range 7 to 60h）. Conservative managements included intra-acavernous injection of phenylephrine, aspiration and heparin-fluid irrigation. With local anesthesia, Winter surgery was performed. A sharp-point knife was inserted transglans to corporal cavernosa, then turned 90° to do the crucial incision. Inserting a 21G needle, heparin-fluid irrigation was performed until detumescence. If one-side shunt was not effective, another shunt was given in the opposite side. Intravenous injection of dextran and oral aspirin ware given for 1 week and 1 month respectively.Results Most patients had recovered detumescence after shunt procedure. 4 cases were treated with one-side shunt, 11 cases were treated with double-side shunt, among them 2 case needed re-procedure. All except 7 patients who had comtinued treatment for AGL had discharged in 7~10 days. 8 patients had been followed up for 1~6 years （average 3.2 years）. IIEF-5 was used to score the patients erection satisfaction. 6 cases were satisfactory or generally satisfactory , 2 cases were not satisfactory or complete erectile dysfunction.Conclusion Winter surgery could be effective to treat refractory ischemic priapism and at long term follow-up some patients still maintain satisfactory erection.