血管性勃起功能障碍特殊检查的临床应用(附105例报告)

Role of duplex ultrasonography,internal pudendal arteriogram and cavernosography in the diagnosis of vascular erectile dysfunction

目的应用双功能超声、阴部内动脉造影和海绵体造影三项血管性勃起功能障碍(ED)主要特殊检查结合海绵体血管活性药物注射,对血管性ED动脉功能和静脉关闭机制进行评估。方法105例血管性ED,其中12例有骨盆骨折尿道断裂。本组病人先行阴茎双功能超声检查,判断动脉功能和静脉关闭机制异常情况。外伤动脉性ED病人进一步行阴部内动脉造影,静脉性ED进一步行海绵体造影。结果(1)阴茎双功能超声检查显示,动脉性ED63例,静脉性ED42例;(2)12例外伤性动脉性ED阴部内动脉造影显示,阴茎勃起供血动脉受损,包括阴茎动脉主干狭窄、断裂和阴部内动脉断裂;(3)42例静脉性ED阴茎海绵体造影显示静脉漏,包括背深静脉漏、脚静脉漏、海绵体间静脉漏和混合性静脉漏。结论(1)双功能超声检查提供了阴茎勃起血流动力学异常的客观数据,可鉴别动脉功能或静脉关闭机制异常,为血管性ED第一线检查方法;(2)动脉造影检查可对阴茎供血动脉病变损伤部位进行解剖定位;(3)海绵体造影检查提供了静脉漏病变的解剖部位,后二项造影检查可为手术方案制定提供客观依据。

Objective To study the role of duplex ultrasonography （DU）, internal pudendal arteriogram （IPA） and cavernosography in the diagnosis of vascular erectile dysfunction. Methods One hundred and five patients with vascular erectile dysfunction （ED） were examined by duplex ultrasonography. Twelve arteriogenic ED caused by pelvic fracture trauma were examined using internal pudendal arteriogram. Patients with venogenic ED were examined using cavernosography. Papaverine and phentolamine were used for intracavernous injection. Results DU suggested that sixty-three patients were arteriogenic ED and forty-two patients were venogenic ED. IPA suggested that twelve arteriogenic ED patients caused by pelvic fracture trauma had artery injuries, including internal pudendal artery injury, right or left common penile artery injury only and both right and left common penile artery injuries. Cavernosography suggested that patients with venogenic ED had venous leakage, including deep dorsal vein leakage, crntal vein leakage,oleakage among corpus cavernosum and complicated leakage. Conclusion DU plays an important role in the diagnostic workup of patients with vascular ED. This accurate and reproducible method is useful to evaluate both arterial and venous hemodynamic abnormalities in patients with suspected vasculogenic ED. DU is the first-line test to define the vasculogenic ED. IPA is performed to confirm the location of arterial lesion. Cavernosography is performed to confirm the sites of leakage.