阴茎异常勃起的诊治流程:附6例报告

Proceeding management of priapism: report of 6 cases

目的探讨阴茎异常勃起的规范诊治流程。方法回顾分析我院6例勃起时间超过24 h,经保守治疗无效的患者,其中服用西地那非后性交所致1例,应用血管活性药物所致1例,会阴外伤所致1例,原因不明3例。给予海绵体血气分析、阴茎彩色多普勒超声检查,5例低流量型异常勃起患者行阴茎头阴茎海绵体分流术,1例高流量型异常勃起患者行选择性阴茎海绵体动脉栓塞术。结果 6例患者持续勃起均消退,未见复发。随访2～24个月,5例低流量型阴茎异常勃起患者出现不同程度的海绵体纤维化或勃起功能障碍,1例高流量型阴茎异常勃起患者恢复正常。结论彩色多普勒超声、海绵体血气分析及选择性阴茎海绵体动脉造影等系统性检查是必要的,有助于阴茎异常勃起的准确诊断。对于低流量型异常勃起,早期的系统性诊治是避免术后海绵体纤维化、勃起功能障碍发生的关键。

Objective： To explore the proceeding management of priapism. Methods. Six patients with priapism failed in conservative therapy in other hospitals and the duration was over 24 hrs. They were evaluated by cavernous blood gas analysis and color duplex ultrasonography. One case of priapism resulted from oral sildernifil, 1 from intracavernosal injection of vasoactive agent, 1 from perineal trauma and 3 from unknown causes. Among them, 5 patients with low-flow underwent corpora cavernosa-corpus spongiosum shunt and 1 with high-flow priapism underwent selective cavernous artery embolization under DSA. Results. After treatment, all patients achieved complete detumescence. During 2 to 24 months followup, 5 cases with low-flow priapism developed cavernous fibrosis of penis or erectile dysfunction, 1 case with high-flow priapism recovered. Conclusions： Color duplex ultrasonography, cavernous blood gas analysis and digital subtraction angiography（DSA）are necessary in diagnosing priapism accurately. Proper and early treatment is essential to avoid cavernous fibrosis and erectile dysfunction especially in low-flow priapism.