明胶海绵超选择血管栓塞治疗高流量性阴茎异常勃起五例

Super- selective endovascular embolization with Gelfoam for the treatment of high- flow priapism

目的：探讨使用明胶海绵经导管超选择性栓塞治疗高流量性阴茎异常勃起的临床疗效。方法2004年4月-2010年11月收治5例高流量性阴茎异常勃起患者，其中4例有明确外伤史，1例为直肠癌阴茎转移。所有患者均行海绵体血气分析、海绵体彩色多普勒超声（彩超）以及髂内动脉造影检查，确认血管异常后以明胶海绵行超选择性阴部内动脉栓塞。术后随访30～109个月。结果5例患者彩超均提示海绵体动脉高速低阻血流，3例患者海绵体球部可见明确异常血池。1例血管造影可见右侧阴部内动脉-海绵体瘘，2例可见左侧阴部内动脉-海绵体瘘，1例右侧阴茎背动脉及阴茎海绵体动脉增粗，1例患者双侧阴部内动脉异常增粗。栓塞后所有患者异常勃起症状即刻消失，术后随访除阴茎转移癌患者于栓塞后7个月死亡外，所有患者性功能均恢复到伤前水平。结论采用明胶海绵超选择性栓塞阴部内动脉是治疗高流量性阴茎异常勃起的有效方法，明胶海绵作为栓塞剂可以很好地保护勃起功能。

Objective To investigate the clinical efficacy of super-selective transcatheter embolization with gelatin sponge in treating high-flow priapism （HFP）. Methods During the period from Apr. 2004 to Nov. 2010, 5 patients with high-flow priapism were admitted to authors’ hospital. Of the five patients, four had a definite history of trauma and one had penile metastasis from rectal cancer. Blood gas analysis and color Doppler ultrasonography of cavernous body of penis, and internal iliac arteriography were performed in all the five patients. When arterial abnormalities were identified, super-selective arterial embolization with Gelfoam was carried out to obstruct the injured artery. After the treatment the patients were followed up for 30 - 109 months. Results Color Doppler ultrasonography of cavernous body of penis showed that cavernous artery blood flow presented a high-speed low-impedance pattern in all five patients. Obvious abnormal blood pool in cavernous bulb was seen in three patients. Angiography revealed right internal pudendal artery-sponge body fistula in one patient, and left internal pudendal artery-sponge body fistula in another two patients. Thickened right dorsal penile artery and cavernous artery of penis was found in one case, and abnormally thickened bilateral internal pudendal artery was detected in another case. Immediately after the embolization procedure the abnormal penis erection disappeared in all patients. Postoperative follow-up showed that all patients’ erectile function was restored to pre-injury level except the patient with penile metastasis, who died seven months after the operation. Conclusion Super-selective cavernous artery embolization with gelatin sponge is a safe and effective treatment for high-fiow priapism. The use of gelatin sponge can ensure a successful embolization and preserve the erectile function as well.（J Intervent Radiol, 2014, 23：337-340）.