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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 the anastomosis of the internal iliac artery and the renal artery graft affects the blood supply and erectile function of the penis. Prospective assessment of the anastomosis of the internal iliac artery and graft renal artery by measuring the penile arterial blood flow before and after transplantation Penis blood supply and erectile function. Methods: Thirty-three patients with maintenance hemodialysis (MHD) underwent living donor kidney transplantation. The right internal iliac arteries and the graft renal arteries were anastomosed during transplantation. Before transplantation and 6 months after transplantation, we received a questionnaire mainly based on the International Index of Erectile Function. The penile Doppler blood flow, serum creatinine, hemoglobin and cholesterol level before and after transplantation were recorded, and immunosuppressive therapy after transplantation was recorded. RESULTS: Thirty-three patients with MHD were 21-55 years of age. Erection dysfunction was present in 36% of patients during hemodialysis and erectile dysfunction was present in 33% of patients after transplantation. Erection did not change in 67% of the patients complained of erectile dysfunction, erectile dysfunction in 15% and erectile dysfunction in 18% of the patients, including 2 patients with preoperative erectile dysfunction. The scores of erectile function before and after transplantation were (24.6 ± 5.1) and (24.2 ± 6.2), respectively, with no significant difference (P> 0.05). Before and after transplantation, there was no significant difference in ejaculation function, insertion satisfaction and overall satisfaction. However, in the aspect of sexual desire, the score of sexual desire after transplantation was significantly higher than uremia (6.2 ± 1.6 vs 8.9 ± 0.9, P <0.01). All patients received full erection after injection of penicillin. The results of Doppler ultrasound showed no penile artery insufficiency. The diastolic blood flow velocity (EDV) and resistance index (R I) were abnormal in 6 patients. The peak systolic blood flow (PSV) after transplantation was significantly lower than that before transplantation (45.9 ± 8.9 vs 41.3 ± 8.0 on the left, P <0.01; 46.5 ± 8.6 vs41.5 ± 8.1 on the right, P <0.01) Patients with penile artery insufficiency; 8 patients with EDV and RI abnormalities. CONCLUSION: Unilateral internal iliac artery occlusion significantly reduces the penile artery blood flow, but ED compensation will not be caused by the compensation of the contralateral internal iliac artery due to inadequate penile blood supply. Male renal transplant recipients use the internal iliac artery and the graft kidney Arterial end anastomosis, no negative effect on penile erection.