经尿道泌尿外科手术中阴茎异常勃起阶梯式处理的疗效研究

Efficacy of 'multi-step method' in treating abnormal penile erection resulting from transurethral urological surgical operations

目的探讨经尿道泌尿外科手术中阴茎异常勃起的有效处理方法。方法在经尿道手术时发生阴茎勃起的47例患者,按下列进程行阶梯式逐级处理:观察等待→冰水冷敷→利多卡因阴茎背神经阻断→静脉应用右美托咪定→阴茎海绵体内注射去氧肾上腺素→阴茎穿刺放血,以使阴茎勃起消退;观察各种方法对阴茎勃起消退的效果。结果术中阴茎勃起后,通过加深麻醉及停止手术操作及刺激,就有17. 0%(8/47)的患者10 min内勃起自行消退。剩下的39例患者继续经上述进程逐级处理后,依次分别有10、17、8、3、1例发生勃起消退。促使阴茎勃起消退有效率最高的方法分别是阴茎穿刺放血(100%)、阴茎海绵体内注射去氧肾上腺素(75%)和静脉应用右美托咪定(66. 7%),起效最快的方法分别为阴茎海绵体内注射去氧肾上腺素(1. 7±0. 6 min)、阴茎穿刺放血(2min)和阴茎背神经阻滞(5. 1±2. 3 min)。结论本研究所采用的阶梯式处理麻醉手术中阴茎勃起的方法,效果确切。其中所采用的各方法中又以阴茎海绵体内给予去氧肾上腺素的有效率较高,起效时间最快。

Objective To evaluate the efficacy of a‘multi-step method’in treating abnormal penile erection resulting from transurethral urological surgical operations.Methods Firstly,47 patients who experienced abnormal penile erection during transurethral urological surgery were chosen as the subjects of study.They were then subjected to a‘multi-staged method’to soften the erection which followed steps as watchful waiting→cold compressing with ice water→penile dorsal nerve blocking with lidocaine→intravenous application with dexmedetomidine→intracavernous injection with phenylephrine→bloodletting with penile puncture.Then the penile detumescence was evaluated.Results Erection detumescence was obtained in 8 out of the 47 cases(17.0%)within 10 min after intensifying anesthesia and suspending surgical operations as abnormal erection occurred.The other 39 cases of abnormal erection were then subjected to the above multi-step method and then erection detumescence was observed in 10 cases,17 cases,eight cases,three cases and one case out of the subjects as the steps were take successively respectively.Three Methods were found to be highly effective in terms of rate of engendering erection detumescence,namely,bloodletting with penile puncture(100%),intracavernous injection with phenylephrine(75%)and intravenous application with dexmedetomidine(66.7%).Three Methods were found to be the fasted in bringing about detumescence,namely,intracavernous injection with phenylephrine(1.7±0.6 min),bloodletting with penile puncture(2 min)and penile dorsal nerve blocking with lidocaine(5.1±2.3 min).Conclusions The‘multi-step method’proposed in the paper proved to be highly effective in treating abnormal penile erection.Of all the Methods,intracavernous injection with phenylephrine was the fastest and most efficient method in engendering erection detumescence.