高原地区应用可视化精准电生理诊断与治疗佩罗尼氏病

Visualized Precise Electro-physiological Diagnosis and Treatment of Peyronie's Disease in Plateau Areas

【目的】探讨高海拔缺氧地区应用精准电生理诊断与经皮低频电刺激治疗阴茎硬结症的效果及治疗方案。【方法】回顾性分析纳入电生理诊断与治疗阴茎海绵体硬结症患者共54例。年龄20~70岁,平均(45.5±11.6)岁,病程2~16月。治疗前均口服PDE5i、左卡尼汀口服液、活血化瘀中药等,治疗前停所有口服药物1周后进行可视化精准电生理诊断,记录并对比设定治疗前后电生理诊断参数,调整精准电生理相应参数进行经皮低频电刺激治疗,每次2~3 h、每日1次、每疗程10次。同时辅助鼻导管吸氧2~3 h(4 L/min)。电生理诊断与治疗前后应用《疼痛程度数字评估量表》、勃起功能国际问卷-5(IIEF-5)、阴茎弯曲度测量、阴茎彩色多普勒测量斑块面积大小及全身与疾病局部红外热像图温度变化对比评估。【结果】所有患者均顺利完成经皮低频电刺激治疗2~4疗程(20~40次)。疲软/勃起疼痛程度治疗前后均值对比(7.1±1.6 vs 2.0±1.0),差异有统计学意义(P<0.01);IIEF-5治疗前后均值对比(8.2±3.2 vs 16.0±5.1),差异有统计学意义(P<0.01);PCDDU测量斑块面积治疗前后均值对比0.23(0.09~0.54)cm^(2) vs 0.23(0.09~0.54)cm^(2),改善值无变化,差异无统计学意义(P=0.189);4例无阴茎弯曲畸形,电刺激治疗前50例(92.6%)患者有不同程度的阴茎弯曲畸形,治疗前后对比弯曲角度改善无变化,差异无统计学意义(P>0.05)。可视化精准电生理诊断治疗前后比较TMT图提示全身及阴茎、双侧腹股沟区等温度变化>1.5℃,属于有效电刺激治疗。随访3~10个月无复发硬结、疼痛和阴茎弯曲畸形加重、无1例患者需要后续手术。【结论】本研究结果发现可视化电生理诊断情况设定局部与整体相结合治疗参数,通过中医经络穴位、神经肌肉经皮低频电刺激治疗佩罗尼氏病(PD)安全性良好、疗效肯定,特别是在早期阶段对疼痛治疗效果明显,为PD治疗开辟了新途径。

【Objective】To investigate the efficacy and treatment options of precise electrophysiological diagnosis com-bined with percutaneous low-frequency electrical stimulation for penile scleroderma in high-altitude hypoxic areas.【Meth-ods】A total of 54 patients with electrophysiological diagnosis and treatment of corpora cavernosa were included in the retro-spective analysis.Their age ranged from 20 to 70 years with a mean of 45.5±11.6 years and disease duration from 2 to 16 months.PDE5i,levocarnitine oral solution,and traditional Chinese medicine for invigorating blood circulation and elimi-nating stasis were administered orally before treatment.The visual precision electrophysiological diagnosis was performed after discontinuation of all oral drugs for 1 week before treatment.The electrophysiological diagnostic parameters were re-corded and contrasted before and after the set-up treatment,and the corresponding parameters for precision electrophysiol-ogy were adjusted for percutaneous low-frequency electrical stimulation treatment,2-3 hours each time,once daily,and 10 times per course.At the same time was administered assisted nasal cannula oxygen inhalation for 2 to 3 hours(4L/min).Before and after electrophysiological diagnosis and treatment were evaluated by using the numeric assessment scale of pain extent,the international index of erectile function score(IIEF-5),penile curvature measurement,color Doppler measure-ment of plaque areas and comparison of whole body and disease local infrared thermogram temperature changes.【Results】All patients successfully completed 2-4 sessions of percutaneous low-frequency electrical stimulation(20 sessions to 40 sessions).There was a significant statistical difference(P<0.01)between the mean values before and after treatment for the degree of weakness/erection pain(7.1±1.6 vs 2.0±1.0);(8.2±3.2 vs 16.0±5.1)before and after IIEF-5 treatment,re-spectively(P<0.01),Pre-and post-treatment of PCDDU measured mean plaque size was 0.23(0.09~0.54)cm^(2) vs 0.23(0.09~0.54)cm^(2),with no statistically different change in improvement value(P=0.189).Four cases had no penile campto-dactyly,Before electrical stimulation,50(92.6%)patients had different degrees of penile curvature deformity,and there was no change in the improvement of the contrast bending angle before and after treatment(P>0.05).The comparison of TMT images before and after treatment with visual precision electrophysiology diagnosis suggested that temperature change>1.5℃in the whole body and penile and bilateral inguinal regions,etc.could be considered effective electrical stimulation treatment.There were no recurrences of induration,increased pain and penile curvature at 3~10 months followup,and no patient required subsequent surgery.【Conclusion】The results of this study show that visualizing the electro-physiological diagnosis situation to set local and holistic combined treatment parameters,and treating PD by means of per-cutaneous low-frequency electrical stimulation at meridian and neuromuscular acupoints of traditional Chinese medicine could achieve good safety and efficacy,especially in the early stage,which has a clear effect on pain treatment,thus open-ing new avenues for PD treatment.