动脉外伤性勃起功能障碍的诊断和治疗(附4例报告)

Diagnosis and treatment of trauma-associated arteriogenic erectile dysfunction

目的 探讨动脉外伤性勃起功能障碍的诊断和治疗。方法 4例骨盆骨折外伤引起阴茎动脉供血受损所致ED ,阴茎海绵体血管活性药物注射后仅见阴茎轻度胀大 ,球海绵体肌反射试验正常。并行药物性阴茎多谱勒超声检查 (PPDU)和药物性阴部内动脉造影检查 (IPA) ,其中 3例行腹壁下动脉和阴茎背浅动脉吻合术。结果 术前PPDU和IPA显示 ,1例双侧海绵体动脉及血流均未显示 ,左侧阴部内动脉和右侧阴茎动脉主干断裂 ,2例双侧海绵体动脉血管均低于正常 ,双侧阴部内动脉及阴茎动脉主干未显示明显异常。 1例右侧海绵体动脉血流正常 ,左侧海绵体动脉血流明显低于正常 ,左右海绵体动脉近端有交通枝 ,左侧阴茎动脉主干断裂。 3例手术后随访 ,1例完全恢复正常自然勃起 ,2例阴茎海绵体血管活性药物注射后阴茎达正常勃起。结论 骨盆骨折可造成阴茎勃起血供受损 。

Objective To study the diagnosis and treatment of the trauma associated arteriogenic erectile dysfunction.Methods Four patients suffers from arteriogenic erectile dysfunction caused by pelvic fractures trauma.Before operation they were examined using pharmacopenile duplex ultrasonography(PPDU) and internal pudendal arteriogram(IPA).Dorsal artery inferior epigastric artery anastomosis were performed in 3 cases.Results PPDU and IPA suggested that both cavernous arteries and blood flow were not seen in 1 case in 2 cases both PSV of cavernous artery were less than normal level,and in 1 case the PSV of right cavernous artery was normal,the PSV of left cavernous artery was less than normal level.Injury of left common penile artery was comfirmed.After operation one recovers normal erection spontaneously and two have rigid erection induced by intracavernous injection.Conclusions Trauma associated arteriogenic erectile dysfunction may result from common penile artery and internal pudendal artery injury.Penile revascularization has the potential to permanently cure the patients.