选择性阴部内动脉造影在动脉性勃起功能障碍诊断中的应用

Selective internal pudendal arteriography in the diagnosis of arteriogenic erectile dysfunction

目的:探讨选择性阴部内动脉造影的操作流程及其在动脉性ED诊断中的价值。方法:选择阴茎海绵体动脉血流收缩期峰速(PSV)<25 ml/s并且NPT异常,高度怀疑动脉性ED患者62例,对其进行选择性阴部内动脉造影检查,观察并测定阴部内动脉主干的狭窄程度以及阴茎背动脉和阴茎海绵体动脉的显影长度。结果:21例患者阴部内动脉主干、阴茎背动脉、阴茎海绵体动脉均显影良好;7例患者阴部内动脉主干狭窄;37例患者阴茎背动脉或(和)阴茎海绵体动脉显影长度不足;3例患者同时有阴部内动脉主干狭窄和阴茎背动脉或阴茎海绵体动脉显影长度不足。仅3例患者股动脉穿刺部位皮下血肿,无其他并发症。结论:选择性阴部内动脉造影能够显示供应阴茎的动脉的解剖形态学上的变化,对动脉病变部位做出定位,还能判断阴茎动脉的血流情况,并可以指导此类患者治疗方案的选择,可作为动脉性ED诊断的金标准。

Objective:To explore the procedure of selective internal pudendal arteriography(IPA)and its application in the diagnosis of arteriogenic erectile dysfunction(AED).Methods:We performed selective IPA for 62 patients highly suspected of AED with abnormal nocturnal penile tumescence(NPT)and peak systolic velocity(PSV)of the penile cavernosal artery<25 ml/s.Using digital subtraction angiography,we assessed the stenosis of the main internal pudendal artery and measured the lengths of the dorsal penile arteries and cavernosal arteries.Results:Of the total number of patients,21 were found with normal internal pudendal arteries,dorsal penile arteries and cavernosal arteries,7 with abnormal pudendal arteries and atherosclerotic lesions,37 with inadequately visualized dorsal penile arteries and/or cavernosal arteries,and 3 with both abnormal pundendal and dorsal penile arteries or inadequately visualized cavernosal arteries.No complications were observed except for 3 cases of subcutaneous hematoma at the puncture site.Conclusion:Selective IPA can display the morphological features of internal pudendal,dorsal penile and cavernosal arteries and help to localize arterial lesions and evaluate blood supply in the penile artery.Therefore,it is a safe and reliable method for the diagnosis of AED.