平阳霉素结合糖皮质激素多点注射治疗龟头静脉畸形疗效观察

Multipoint injection for the treatment of venous malformations of glans penis with the mixture of bleomycin A5 and hydroprednisone

目的：探讨龟头静脉畸形的治疗方法，评价平阳霉素结合糖皮质激素多点注射治疗龟头静脉畸形的疗效。方法：收集2005年7月～2013年7月笔者科室就诊患者17例，明确诊断为龟头静脉畸形，采用阴茎海绵体临时阻断，静脉畸形区域多点注射平阳霉素加氢化泼尼松的溶液。进针深度控制适当，避免过浅产生水疱及溃烂，过深损伤尿道，注射后约5min松开止血带。治疗后注意观察阴茎肿胀情况及龟头血运，4周后复诊，观察疗效并决定下一个疗程治疗时间。结果：所有患者龟头静脉畸形均获得良好疗效。第1次治疗1个月后，静脉畸形明显缩小，龟头外形改善，经过3～4次治疗，龟头静脉畸形可完全治愈。3例患者注射后龟头肿胀明显，其中1例起疱，治疗后均恢复。结论：通过给龟头局部分次多点注射平阳霉素结合皮质激素溶液，可有效治疗龟头静脉畸形，，临时阻断海绵体回流，有利于药物局部作用延长，提高疗效。治疗时应注意保护尿道，避免损伤。

Objective To evaluate the efficiency of multipoint injection for the treatment of venous malformations of glans penis with the mixture of bleomycin A5 and hydroprednisone （MBH）.Methods Between July,2005 and July,2013,seventeen cases were clinically diagnosed with venous malformations of glans penis. After the circulation of corpus spongiosum was temporarily occluded by the tourniquet, the multipoint injection of MBH was performed. In order to avoid blisters or ulcer occurring on the glans penis if the injection performing was too superficial, or injury of urethra if too deep, the injection depth should be proper. The tourniquet was removed five minutes after injection. The swelling and blood circulation of glans and penis were observed for about thirty minutes. The treatment was performed at an interval of four weeks. Results Satisfactory response was obtained in all cases. After one cycle of treatment, the lesions became shrank, the shape of glans improved obviously. With three or four cycle of treatment, all the lesions completely regressed. Obvious swelling of glans and penis was observed in three cases, of which blisters on the glans penis occurred in one case. All the complications were cured by appropriate treatment. Conclusion Multipoint injection of MBH for the treatment of venous malformations of glans penis is safe and effective. Temporarily occlusion of the circulation of corpus spongiosum could prolong the time of agent acting on the lesion, which may be companied with better effectiveness. The injury of urethra should be avoided when performing the injection.