创伤后高血流量阴茎异常勃起三例诊治分析

Diagnosis and Treatment of High Flow Priapism after Injury

目的探讨高血流量阴茎异常勃起的临床特点、诊疗方法及疗效。方法回顾性分析我院自1998年1月—2009年1月收治的3例高血流量阴茎异常勃起患者的临床表现、实验室检查、治疗及其效果。结果本组3例,均有阴茎或会阴部创伤史,阴茎均处于勃起状态。海绵体穿刺血呈鲜红色,血气分析结果接近动脉血;彩色多普勒超声检查发现一侧阴茎海绵体动脉血流速度增快,并且于裂口处附近有不均匀的异常湍流回声。2例保守治疗后予观察随访,分别于伤后2个月和4个月阴茎完全恢复疲软,勃起功能良好;1例用明胶海绵行超选择性阴部内动脉栓塞术,术后阴茎疲软,随访6个月,勃起功能恢复良好。结论高血流量阴茎异常勃的诊断依据详细的病史、体格检查、阴茎海绵体彩超及海绵体血气分析。根据病情可选择保守治疗、等待观察或超选择性阴部内动脉栓塞术,手术一般作为最后的选择。其治疗效果一般较好。

Objective To discuss the clinical feature,diagnosis,treatment and prognosis of high flow-priapism （HFP）.Methods The clinical data and follow-up records of 3 patients with HFP from January 1998 to January 2009 in our hospital were retrospectively analyzed.Results All the 3 patients with HFP had traumatic history of the penile or perineum injury,and their penes were in priapism state.The blood from puncture of the penis cavernosa was bright red,and the result of its gas analysis was like that of artery blood.Color Doppler ultrasonography found that the artery blood flow velocity of one side of penis caverneum was increased,and with uneven abnormal echo of turbulent flow near the cleft.Two patients received watchful waiting after conservative treatment;the time of sufficient detumescence of the penis was respectively 2 months and 4 months after injury.One patient underwent superselective embolization of internal pundendal artery with absorbable gelatin sponge,the penis achieved sufficient detumescence after operation.Their erection function was recovered after 6 months follow-up.Conclusion The diagnosis of HFP dependes on detailed history,physical examination,color Doppler ultrasonography,blood gas analysis of penis cavernosa.According to the condition of patients,conservative treatment,watchful waiting or superselective embolization of internal pundendal artery may be chosen,and operation is the last choice.