阴茎海绵体注射结合声视觉性刺激在实时超声诊断血管性勃起功能障碍中的意义

摘要

Objective To evaluate the role of intracavernous injection(ICI) and audio-visual sexual stimulation (AVSS) during real-time pharmacopenile Doppler ultrasonography(PDDU) in diagnosis of vasculogenic subtypes of erectile dysfunction. Methods A total of 200 patients with erectile dysfunction(ED) were enrolled in the study. Each patient received a test of real-time PDDU twice. The method A was performed under intracavernous injection(ICI) alone, and the method B was performed under the combination of ICI and AVSS. The interval time for two tests was 7 days. Some penile vascular parameters including peak systolic velocity(PSV), end diastolic velocity(EDV),and resistive index(RI) were measured and recorded at the 5, 10 and 20min after examination. Results For the veno-occlusive ED patients, the EDV at 10min was significantly greater than that of at 5 and 20 min ( P<0.05) using method A. For the arteriogenic ED, there were significant differences in PSV among different time points using method B ( P<0.05). For the mixed vasculogenic ED patients, there were significant differents in PSV among different time points , meanwhile a EDV at 5min was greater than that of at 10 and 20min(P<0.05). Using Doppler ultrasonography with ICI alone, 34 (17%), 35(17.5%), 31(15.5%) and 100(50%)cases of arteriogenic, veno-occlusive, mixed vasculogenic and non-vasculogenic ED were dianosed respectively, and using PDDU with ICI plus AVSS, 27(13.5%), 44(22%), 7(3.5%) and 122(60.7%)cases were diagnosed respectively. Diagnosis of mixed vasculogenic ED was significantly imroved using method A , anddiagnosis of non-vasculogenic ED was significantly improved( P<0.05). Conclusion The combination of ICI and AVSS during PDDU improves the recording of physiologic erectile response, and itis helpful to evaluate the function of penile erection accurately.%　　目的探讨阴茎海绵体注射(ICI)结合声视觉性刺激(AVSS)在实时超声诊断血管性勃起功能障碍中的应用价值.方法200名门诊诊断勃起功能障碍(ED)患者.每位患者均先后接受A、B两次实时超声阴茎检查.A即在单独ICI下完成,B即在ICI结合AVSS下完成.检查间隔时间为一周.检查指标包括检测ICI后第5、10、20min的收缩期峰值流速(PSV)、舒张末期峰值流速(EDV)、血流阻力指数(RI).结果 A测试中,静脉性ED患者,EDV指标在检测ICI后的第10min明显高于其他时间段,差异有统计学意义(P<0.05).B测试中,动脉性ED患者,PSV 指标各时间段差异均有统计学意义(P<0.05),且动静脉混合型ED患者,EDV指标在ICI后第5min明显高于其他时间段,差异有统计学意义(P<0.05).通过超声检查诊断,A测试中动脉性、静脉性、动静脉混合型以及非血管性ED的情况是34例(17%)、35例(17.5%)、31例(15.5%)和100例(50%)；而在B测试中各组情况是27例(13.5%)、44例(22%)、7例(3.5%)和122例(60.7%).两次检测比较发现,A测试中,动静脉混合型ED显著高于B测试,而B测试中非血管性ED显著高于A测试(P<0.05).结论实时超声检测中联合应用ICI和AVSS可提高阴茎勃起反应,这种方法有助于提高超声评估阴茎海绵体血管功能的准确性.