Kaufman J M, Kaufman J L, Fitch W P
Aurora Regional Medical Center, Colorado, USA.
Int J Impot Res. 1995 Sep;7(3):157-64.
Deep dorsal vein (DDV) arterialization has developed as a treatment option for patients with arteriogenic impotence, especially in situations where artery-to-artery bypass is not feasible. The inferior epigastric artery (IEA), harvested through a lower abdominal incision, has usually served as the neoarterial source. Using dynamic infusion cavernosometry and cavernosography (DICC) to evaluate arterial and venous erection factors and pudendal arteriography to define arterial anatomy, we have identified 16 patients with cavernosal artery (CA) obstruction and a normal dorsal artery (DA) to serve as the neoarterial source. All patients were less than 50 years old (mean 34.8 +/- 8.6 years). During DICC, the gradient between systemic and CA systolic occlusion pressures averaged 38.7 mmHg. Two patients showed moderate and two minimal corporal veno-occlusive dysfunction (CVOD). From 1991-94, all 16 underwent microscopic DA-DDV arterialization. Four of these patients also underwent venous ligation procedures and three had IEA bypass to the other DA. With adequate follow-up in 15 men, the results for six are considered excellent or normal (40%); eight improved (53.3%) and one was unchanged. In the improved group are three men who did not respond adequately to maximum penile injection therapy before surgery but used small doses afterward with success. Of the three smokers in the series, two were improved and one unchanged. Excellent results were found in four of five men (80%) under age 30 but only one of five (20%) over age 40. Complications included two instances of penile shortening and one of glans hyperemia requiring reoperation. By avoiding an abdominal approach, operative times, morbidity and recovery were substantially shortened. This operative approach can provide an excellent treatment for nonsmokers with CA obstruction and a normal DA.
阴茎背深静脉（DDV）动脉化已成为治疗动脉源性阳痿患者的一种选择，特别是在动脉到动脉搭桥不可行的情况下。通过下腹部切口获取的腹壁下动脉（IEA）通常作为新的动脉来源。我们使用动态灌注海绵体测压和海绵体造影（DICC）来评估动脉和静脉勃起因素，并通过阴部动脉造影来确定动脉解剖结构，已确定16例海绵体动脉（CA）阻塞且背动脉（DA）正常的患者作为新的动脉来源。所有患者年龄均小于50岁（平均34.8±8.6岁）。在DICC检查期间，全身和CA收缩期闭塞压之间的梯度平均为38.7 mmHg。两名患者表现为中度，两名表现为轻度海绵体静脉闭塞功能障碍（CVOD）。从1991年至1994年，所有16例患者均接受了显微镜下DA-DDV动脉化手术。其中4例患者还接受了静脉结扎手术，3例患者进行了IEA与另一DA的搭桥手术。对15名男性进行了充分随访，6例结果被认为优秀或正常（40%）；8例改善（53.3%），1例无变化。在改善组中有3名男性，他们在手术前对最大剂量阴茎注射治疗反应不佳，但术后使用小剂量治疗成功。该系列中的3名吸烟者，2例改善，1例无变化。30岁以下的5名男性中有4名（80%）取得了优异结果，但40岁以上的5名男性中只有1名（20%）取得了优异结果。并发症包括2例阴茎缩短和1例龟头充血需要再次手术。通过避免腹部手术入路，手术时间、发病率和恢复时间均大幅缩短。这种手术方法可为CA阻塞且DA正常的非吸烟者提供良好的治疗。
