阴茎勃起功能障碍的检测及法医学鉴定

Detection and Medicolegal Identification of Erectile Dysfunction

目的探讨阴茎海绵体内药物试验、夜间阴茎勃起监测、视听性刺激、阴茎皮肤交感反应等四种检查方法在外伤性阴茎勃起功能障碍的法医学鉴定中的应用价值,分析外伤性阴茎勃起功能障碍的伤残等级评定问题.方法收集50例道路交通事故损伤所致外伤性阴茎勃起功能障碍司法鉴定案例的资料,采用统计学方法对资料进行分析.结果本文资料中损伤构成比为单纯骨盆骨折18例(36%),骨盆骨折伴尿道断裂23例(46%),会阴部软组织损伤、血肿5例(10%),会阴部皮肤撕脱伤4例(8%);交通方式为行人25例(50%),骑自行车12例(24%),乘坐自行车10例(20%),驾驶员3例(6%);阴茎海绵体内药物试验提示阴茎血管功能正常者41例(82%),提示阴茎动脉或海绵体功能障碍者9例(18%);夜间阴茎勃起监测正常17例(34%),轻度异常20例(40%),中度异常11例(22%),重度异常2例(4%);视听性刺激结果正常者42例(84%),异常者8例(16%);阴茎皮肤交感反应正常者23例(46%),异常者27例(54%).结论夜间阴茎勃起监测是最佳的检查方法阴茎海绵体内药物试验、视听性刺激、阴茎皮肤交感反应的检查结果进行综合分析,可有助于判断鉴定.

Objective To discuss the value of four experimental methods of diagnosis ED,including Intracavernous Injection（ICI）,Nocturnal Penile tumescence Testing（NPT）,Audio Visual Sexual Stimulation（AVSS）and Penile Sympathetic Skin Responses（PSSR）,which were used in the medicolegal identification of traumatic erectile dysfunction（ED）,and discuss the assessment of impairment of traumatic ED.Method The data of 50 medicolegally indentified traumatic ED cases caused by traffic accidents were collected and analyzed with statistic methods.Results The constituent ratio of traumatic types were as following： 18 cases（36%）of simple pelvic fracture,23 cases（46%）of pelvic fracture with urethra broken,5 cases（10%）of soft tissue injury on perineal region,4 cases（8%）of avulsion injury of skin on perineal region;25 cases（50%）of pedestrian,12 cases（24%）of bicyclist,10 cases（20%）of seated on bicycle and 3 cases（6%）of automobile drivers.The results of ICI showed 41 cases（82%）had normal the function of blood vessel of penis,9 cases（18%）had dysfunction of arteria penis or spongy body.The results of NPT showed 17cases（34%）had normal nocturnal penile erection,20 cases（40%）had slight dysfunction,11 cases（22%）had moderate dysfunction,and 2 cases（4%）had severe dysfunction.The results of AVSS showed 42 cases（84%）had normal penile erection,and 8 cases（16%）had abnormal dysfunction.The results of PSSR showed 23 cases（64%）were normal and 27 cases（54%）abnormal.Conclusions NPT is the best method to diagnose ED and which can discriminate psychogenic or organic ED.To assessment the degree of impairment of ED,we should comprehensively analyze the results of ICI,NPT,AVSS and PSSR to get the consequence.