动态超声在观察血管性勃起功能障碍患者阴茎血流动力学上的临床应用效果

Clinical application of dynamic ultrasound in observing penile hemodynamics in patients with vascular erectile dysfunction

目的分析讨论在观察血管性勃起功能障碍(erectile dysfunction,ED)患者阴茎血流动力学中应用动态超声的具体效果和实际价值。方法选取2017年5月至2019年3月深圳市南山区蛇口人民医院诊治的血管性勃起功能障碍患者148例,并选取同期心理性勃起功能障碍患者86例作为研究对象。通过阴茎海绵体注射血管活性药物(ICI)试验联合阴茎彩色双功能多普勒超声检查(CCDU)超声评估和海绵体造影,对入选患者阴茎海绵体进行血流动力学检测,分析两者诊断率。检测不同类型勃起功能障碍患者在ICI试验前后CCDU检测阴茎长度和周长变化以及血流动力学参数。结果 ICI试验联合CCDU血管性勃起功能障碍检出率为100.00%(148/148),ICI试验联合海绵体造影检查,检出率为92.57%(137/148),两者比较差异无统计学意义(χ2=0.215,P>0.05)。ICI试验联合CCDU结果显示,动脉型勃起功能障碍51例,静脉型勃起功能障碍44例,混合型勃起功能障碍53例。动脉型勃起功能障碍和混合型勃起功能障碍患者阴茎海绵体内径、PSV、EDV均低于静脉型勃起功能障碍和心理性勃起功能障碍,差异具有统计学意义(P<0.05);动脉型勃起功能障碍和心理性勃起功能障碍RI明显高于静脉型勃起功能障碍和混合型勃起功能障碍,差异具有统计学意义(P<0.05)。ICI前,不同类型勃起功能障碍阴茎周长和长度差异无统计学意义(P>0.05);ICI后,动脉型勃起功能障碍患者阴茎周长和长度明显低于静脉型勃起功能障碍、混合型勃起功能障碍和心理性勃起功能障碍,差异具有统计学意义(P<0.05)。结论使用彩色多普勒超声能够清楚反映血管性勃起功能障碍患者血流动力学情况,判断血管性勃起功能障碍分型,在临床鉴别诊断中具有重要应用价值。

Objective To analyze and discuss the specific effect and practical value of dynamic ultrasound in observing penile hemodynamics in patients with vascular erectile dysfunction(ED). Methods 148 patients with vascular ED in our hospital from May 2017 to March 2019 were selected, and 86 patients with psychological ED in the same period were selected. Intra-cavernous injection of vasoactive drugs(ICI test) combined with color dual function Doppler ultrasonography(CCDU) and cavernography were used in the evaluation of cavernous body. The hemodynamics of cavernous body of penis were measured and the diagnostic rate was analyzed. Before and after ICI test, the length and circumference of penis and hemodynamic parameters were measured by CCDU. Results The detection rate of ICI test combined with CCDC was 100.0%(148/148), and the detection rate of ICI test combined with cavernography was 92.57%(137/148), with no statistically significant differences(χ2=0.215, P>0.05). According to the ICI test combined with CCDC, there were 51 cases of arterial ED, 44 cases of venous ED and 53 cases of mixed ED. The diameter, PSV and EDV of penile cavernous body in patients with arterial ED and mixed ED were lower than those in patients with venous ED and psychological ED, with statistically significant differences(P<0.05). RI of arterial ED and psychological ED were significantly higher than that of venous ED and mixed ED, with statistically significant differences(P<0.05). Before ICI test, there was no significant difference in penile circumference and length between different types of ED(P>0.05);After ICI test, the penile circumference and length of patients with arterial ED was significantly shorter than those of patients with venous ED, mixed ED and psychological ED, with statistically significant differences(P<0.05). Conclusions The use of color Doppler ultrasound can clearly reflect the hemodynamics of patients with vascular ED, and judge the classification of vascular ED, which has important application value in clinical differential diagnosis.