彩色多普勒超声诊断高流量性阴茎异常勃起及介入治疗的价值

Evaluation of Doppler ultrasonography in diagnosing high-flow priapism associated with cavernous arterio-venous fistula and the clinical application of interventional embolization therapy

目的探讨彩色多普勒超声诊断伴有海绵体动静脉瘘的高流量性阴茎异常勃起患者的敏感性及经血管内介入栓塞治疗效果。方法 2005年9月至2011年9月收治8例高流量性阴茎异常勃起患者,彩色多普勒超声证实均伴有单侧阴茎海绵体动静脉瘘,内科保守治疗无效。经阴部内动脉造影观察并行动脉介入栓塞治疗,对比治疗前后患侧阴茎背动脉血流收缩期峰值流速(PSV)、舒展末期流速(EDV)、海绵体内压力值、阴茎背动脉血管造影等指标,评估治疗效果并对所有患者随访观察1年。结果 8例患者进行阴茎背动脉栓塞治疗后,阴茎异常勃起程度均显著缓解。阴茎背动脉PSV、EDV、海绵体内压力数值与术前差异均有统计学意义(P<0.01);阴茎背动脉血管造影,瘘口未见对比剂外溢。术后完全恢复时间为1～3 d,平均1.5 d。仅1例患者5 d后复发。随访1年,7例患者性生活正常,1例出现阴茎勃起功能障碍。结论彩色多普勒超声对阴茎海绵体动静脉瘘诊断具有较高敏感性;超选择性动脉栓塞对该病治疗效果安全、有效、持久。

Objective To evaluate the sensitivity of Doppler ultrasonography in diagnosing high-flow priapism associated with arterio-venous fistula in cavernous body of penis,and to discuss the therapeutic efficacy of endovascular interventional embolization.Methods During the period from Sep.2005 to Sep.2011,eight patients with high-flow priapism were admitted to authors’ hospital.Doppler ultrasonography confirmed that unilateral cavernous arterio-venous fistula existed in all patients.As medical management exerted no effect,angiography of internal pudendal artery along with interventional arterial embolization was carried out in all patients.Before and after the treatment,the peak-systolic velocity（PSV） and end-diastolic velocity（EDV） of dorsal artery of penis,the internal pressure of cavernous body,the angiographic findings of dorsal artery of penis,etc.were determined.The results were analyzed,and the clinical efficacy was evaluated.All patients were followed up for one year.Results After interventional embolization of the dorsal artery of penis,the severity of priapism was dramatically relieved.The postoperative PSV and EDV values of dorsal artery of penis,as well as the internal pressure of cavernous body were significantly different from the preoperative ones（P 0.01）.Angiography of dorsal artery of penis showed no contrast extravasation at fistula site.The complete recovery time after the treatment was 1-3 days（mean 1.5 days）.Recurrence was seen in one case at five days after the procedure.During the follow-up period of one year,seven patients enjoyed normal sexual life,while one patient developed astyphia.Conclusion Doppler ultrasonography carries high sensitivity in diagnosing arterio-venous fistula of cavernous body of penis,and super-selectively embolization of dorsal artery of penis is a safe,effective and reliable treatment for high-flow priapism associated with arterio-venous fistula in cavernous body of penis.