联合运用负压理疗及海绵体内药物注射治疗心因性阳痿

Efficacy of combination of vacuum constriction device and intracavernous injection for the treatment of psychogenic erectile dysfunction

目的：评价联合运用真空负压理疗仪（VCD）和海绵体内血管活性药物注射（ICI）治疗心因性勃起功能障碍（PED）的效用和不良反应、方法：对136例PED病人进行上述联合治疗。首先经过各种检查排除器质性因素，同时接受人格测试（MMPI）以评定其人格状况、治疗时在性知识教育、性心理疏导的基础上，分成盐酸罂粟碱＋PGE1和单纯PGE1两组；对所有病人每周均进行1～2次VCD治疗。结果：共计119例接受最终随访评估。罂粟碱＋PGE1组：59例获成功勃起．5例失败问例出现异常勃起）；PGE1组：51例获成功勃起，4例失败。VCD治疗常见的不良反应：治疗时感到缩窄环处疼痛（21例，19．1％），包皮水肿（4例，3．6％），无其他严重的不良反应。联合治疗后行性生活时阴茎平均勃起时间范围为5～45（平均19．4）min。85．7％（102例）在治疗中自主勃起功能改善，75．6％（90例）对自己的勃起功能得到改善或恢复感到满意，73．2％（87例）在随访中表示对上述联合治疗满意。结论：联合运用ICI和VCD治疗心国性勃起功能障碍是一种安全、有效、非侵入性和价廉的治疗方法。

Objectives:To evaluate efficacy and adverse effects of combination of Vaccum Contriction Device (VCD) and intracavernous pharmaco therapy(ICI) on psychogenic erectile dysfunction. Methods: From Feb. 96 to Feb. 98, 136 patients referred for impotence, without hypogonadism, hyperprolactinemia,pelvic fracture or diabetes,were investigated with nocturnal erectorigidometry (NPTR), doppler peno-brachial index (PBI), intracavernous prostaglandin test,cavernosography,cavernosometry if needed. MMPI was used for personal ity assessment. Besides the medical interview,sexual counseling and sexual education,all pa tients were given either papaverine +prostaglandin E1 or prostaglandin only. Successful men streamlined for self-injection program. At same time, all were offered a VCD for once or twice a week. Results: 119 men were evaluated. Mean age of sample was 40.3 years,range 21 to 68 years. Papaverine + prostaglandin E1 group: 59 achieved successful erection and 5 failed. Prostaglandin group: 51 achieved successful erection and 4 failed. The most frequent adverse effect of VCD was pain from the constriction ring in 21 patients(19. 1% ). 4 patients (3.6%) experienced petechiae of skin. No other serious side effects were observed. The mean duration of erection after the combination treatment ranged from 5-45 minutes with an av erage of 19. 4 minutes. 87 patients (73. 2%) were satisfied with the combination therapy. 102 patients (85. 7%) reported about increasing spontaneous erections during the combination therapy. 90 patients (75. 6%) reported satisfaction in rebuilding their sexual activity. Con clusions:The management of combination of lCI and VCD is a safe, non-invasive, cheap and effective option in management of ED in psychogenic patients.