摘要
目的：对髂内动脉与移植肾动脉端端吻合是否影响阴茎血供及勃起功能是有争议的,通过检测移植前后阴茎动脉血流,前瞻性评估髂内动脉与移植肾动脉端端吻合对受者阴茎血供及勃起功能的影响。方法：33例维持性血液透析（MHD）患者,接受了活体肾移植,移植术中使用右侧髂内动脉与移植肾动脉端端吻合。在移植前和移植后6个月,接受了国际勃起功能指数为主的问卷调查,记录移植前后阴茎多普勒血流、血肌酐、血红蛋白、胆固醇水平及移植后免疫抑制治疗方案。结果：33例MHD患者,年龄21~55岁,血液透析期间,36%的患者存在勃起功能障碍,移植后33%的患者存在勃起功能障碍。主诉中67%患者移植后勃起功能没有改变,15%患者勃起功能变差,18%患者勃起功能改善,其中包括2例术前勃起功能障碍患者。移植前后勃起功能方面的评分分别为（24.6±5.1）和（24.2±6.2）,两者无显著差异（P〉0.05）。移植前后患者在射精功能、插入满意度和总体满意度方面没有显著差异;然而在性欲方面,移植后患者性欲评分明显高于尿毒症期（6.2±1.6vs8.9±0.9,P〈0.01）。所有患者在尿毒症期阴茎海绵体药物注射后均获得充分勃起,超声多普勒结果表明不存在阴茎动脉供血不足;6例患者舒张期血流速度（EDV）及阻力指数（R I）异常。移植后收缩期血流峰值（PSV）明显低于移植前（左侧45.9±8.9vs41.3±8.0,P〈0.01;右侧46.5±8.6vs41.5±8.1,P〈0.01）,但无1例患者出现阴茎动脉供血不足;8例受者EDV及R I异常。结论：单侧髂内动脉阻断显著降低阴茎动脉血流,但通过对侧髂内动脉的补偿不会因为阴茎血供不足而导致ED的发生;男性肾移植受者使用髂内动脉与移植肾动脉端端吻合,对阴茎勃起功能没有负面影响。
Objective：It is controversial whether unilateral interruption of the arteria iliaca interna distal end affects penile hemodynamics and erectile function.The purpose of this study was to prospectively evaluate this influence by detecting the blood flow of the penile artery before and after renal transplantation.Methods：Thirty-three patients with chronic renal failure（CRF） on maintenance hemodialysis（MHD） received renal transplantation,the grafts revascularized by end-to-end anastomosis to the right internal iliac artery.Six months before and after the surgery,we obtained the IIEF scores of the patients,recorded their penile blood flow on color Doppler ultrasonography and the levels of serum creatinine,hemoglobin and serum cholesterol,and analyzed post-transplantation immunosuppressive medication.Results：The patients ranged in age from 21 to 55 years,of whom 36% had erectile dysfunction（ED） during MHD,and 33% after renal transplantation.A total of 67% of the renal transplant recipients（RTR） complained of unchanged and 15% deteriorated ED,while 18% admitted improved erectile function.The patients showed a significantly stronger sexual desire after the transplantation than before it（6.2 ± 1.6 vs 8.9 ± 0.9,P 0.01）.There was a significant decrease in peak systolic velocity（PSV） in the cavernous arteries after transplantation as compared with pre-transplantation（P 0.01）.Penile arterial blood flow insufficiency was found in none of the RTRs.Conclusion：Unilateral interruption of the internal iliac artery decreases penile arterial blood flow,but not to such a degree as to result in ED.Unilateral interruption of the arteria iliaca interna distal end does not affect the erectile function of RTRs.
出处
《中华男科学杂志》
CAS
CSCD
北大核心
2010年第4期341-344,共4页
National Journal of Andrology
关键词
髂内动脉
阴茎
勃起功能障碍
肾移植
arteria iliaca interna
penis
erectile dysfunction
renal transplantation
