低流量型阴茎异常勃起的诊治分析

Diagnosis and treatment of low-flow priapism

目的探讨低流量型阴茎异常勃起的临床特点和治疗方法，提高急诊处理水平。方法低流量型阴茎异常勃起患者12例，年龄19～47岁，平均28岁。病程6～24h9例，24。72h2例，1例持续168h。阴茎海绵体内注射血管活性药物致异常勃起6例，白血病3例，口服药物所致1例，不明原因者2例。结合文献分析其治疗方法和预后。结果12例均为低流量型阴茎异常勃起。11例分别采用冰敷、阿拉明注射、阴茎海绵体抽吸和肝素化生理盐水冲洗及原发病治疗，阴茎勃起消退，1例行阴茎海绵体阴茎头分流术治愈。11例患者获得随访，时间6—24个月，4例出现不同程度ED。结论早期行阴茎海绵体抽吸冲洗是低流量型阴茎异常勃起的有效治疗方法，而白血病引起的阴茎异常勃起，阴茎海绵体抽吸冲洗可缓解症状，但易复发，积极治疗原发病多可使异常勃起自行缓解，分流手术多作为第二选择。

Objective To investigate the diagnosis and treatment of low-flow priapism. Methods The clinical data of 12 cases of low-flow priapism were analyzed retrospectively. The age ranged from 19 to 47years （mean 28） and the time of persistent erection lasted for 6~168h （9 cases less than 6~24 h, 2 during 24~72 h and 1 for 168h）. Of them, 6 patients resulted from intracavernosal injecting vaso-active agents, 3 patients from chronic myeloid leukemia, 1 patient from intaked medicine, and the other 2 unknown causes. Results Among these 12 cases of low-flow priapism, they achieved detumescence by intracavernosal injecting aramine, intracavernosal aspiration and perfusing of heparinized saline at corporal cavernosa, and chemotherapy plus leukapheresis for chronic myeloid leukemia, respectively. One of them received glandular cavernosal shunting. After 6-24months following-up, 4 of 11 cases had erectile dysfunction. Conclusion Early treatment of intracavernosal aspiration and perfusing of heparinized saline at corporal cavernosa was an effective theraputical option for low-flow priapism. Chemotherapy plus leukapheresis was recommended as a first choice treatment for priapism caused by chronic myeloid leukemia. Caverno-spongiosum shunt might be also required but controvertible.