远端分流术治疗缺血性阴茎异常勃起

Distal cavernosal-glan Shunt for ischemic priapism

目的提高缺血性阴茎异常勃起（IPP）的治疗水平。方法回顾性分析自2004年1月至2010年6月，我院收治的8例IPP的临床资料：年龄平均34．5岁（22～45岁）；阴茎勃起伴疼痛持续时间平均84．5h（36-132h）：术前超声多普勒检查双侧阴茎海绵体动脉血流，无血流5例，血流减少3例。阴茎海绵体血气分析结果为pH6．561-7．150，PO2l．12-45．4mmHg，PCO266．2-92．1mmHg。分别采取阴茎海绵体抽吸注射和不同术式的阴茎头-阴茎海绵体分流术，术中以新福林肝素盐水灌洗至阴茎疲软。结果Winter分流术成功1例，Ebbehoj成功2例，T-Shunt分流术成功5例。术后超声多普勒和血气分析显示，阴茎血流恢复，pH值和氧饱和度恢复正常。3例失访，5例随访平均3．5年，重度阴茎勃起功能障碍（ED）3例，其中1例行阴茎假体植入术；2例中度ED在药物辅助下可完成性交。结论不同术式的阴茎头．阴茎海绵体分流术联合新福林盐水冲洗，操作简单，能使不同病程的IPP转入疲软状态。

Objective To improve the diagnostic and therapeautic level of ischemic priapism. Methods We retrospectively reviewed the data of 8 cases with IPP who were treated in our hospital from January 2004 to June 2010. The average ages were 34.5 and the mean duration of priapism was 84.5 hours（36 to 132 hours）.With the help of Color duplex doppler ultrasonography （CDDU）, no blood flow was present in cavernosal arterial in 5 cases, and decreased blood flow in 3. Results Successful detumescence was achieved by different operation procedure for all of the cases including 1 with Winter-Shunt,2 with Ebbehoj-Shunt,and 5 with T-Shunt. Post-operative CDDU and blood-gas test showed that aterial flow, pH value of the cavernosal blood and oxygen saturation recorvered. Five of the cases were followed-up and the mean follow-up duration was 3.5 years, which showed that 3 cases hadcomplete erectile dysfunction including 1 case with penile prosthesis implant in and the other 2 case with partial erectile dysfunction. Conclusion With the combination of saline phenylephrine, distal cavernosal-glan Shunt can effectively achieve penis detumescence.