高原地区应用可视化精准电生理诊断与治疗佩罗尼氏病

郭巍; 严积雄; 张强; 陈琦炜; 杨茸茸

doi:10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2022.0603

您当前的位置：

首页 >

文章列表页 >

高原地区应用可视化精准电生理诊断与治疗佩罗尼氏病

男科疾病的诊断与治疗新技术 | 更新时间：2024-02-19

- 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
- 中山大学学报（医学科学版） 2022年43卷第6期页码：884-891
- 作者机构：
  
  西宁市第一人民医院男科，青海西宁 810000
- 作者简介：
  
  郭巍，主任医师，研究方向：男科与生殖，E-mail：gw13519701641@126.com
- 基金信息：
  
  国家卫健委医药卫生科技发展研究中心科研项目(HDSL20201083)
- DOI：10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2022.0603
  中图分类号： R698.1
- 纸质出版日期：2022-11-20，
  
  收稿日期：2022-07-21，
扫描看全文
郭巍,严积雄,张强等.高原地区应用可视化精准电生理诊断与治疗佩罗尼氏病[J].中山大学学报（医学科学版）,2022,43(06):884-891.

GUO Wei,YAN Ji-xiong,ZHANG Qiang,et al.Visualized Precise Electro- physiological Diagnosis and Treatment of Peyronie's Disease in Plateau Areas[J].Journal of Sun Yat-sen University(Medical Sciences),2022,43(06):884-891.
郭巍,严积雄,张强等.高原地区应用可视化精准电生理诊断与治疗佩罗尼氏病[J].中山大学学报（医学科学版）,2022,43(06):884-891. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2022.0603.

GUO Wei,YAN Ji-xiong,ZHANG Qiang,et al.Visualized Precise Electro- physiological Diagnosis and Treatment of Peyronie's Disease in Plateau Areas[J].Journal of Sun Yat-sen University(Medical Sciences),2022,43(06):884-891. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2022.0603.

摘要

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

2.0±1.0），差异有统计学意义（

＜0.01）；IIEF-5治疗前后均值对比（8.2±3.2

16.0±5.1），差异有统计学意义（

＜0.01）；PCDDU测量斑块面积治疗前后均值对比0.23（0.09~0.54）cm

0.23（0.09~0.54）cm

，改善值无变化，差异无统计学意义（

= 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（

＞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。

Abstract

Objective

To investigate the efficacy and treatment options of precise electrophysiological diagnosis combined with percutaneous low-frequency electrical stimulation for penile scleroderma in high-altitude hypoxic areas.

Methods

A total of 54 patients with electrophysiological diagnosis and treatment of corpora cavernosa were included in the retrospective 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 eliminating 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 recorded and contrasted before and after the set-up treatment， and the corresponding parameters for precision electrophysiology 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 measurement 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 （

0.01） between the mean values before and after treatment for the degree of weakness / erection pain （7.1±1.6

2.0±1.0）；（8.2±3.2

16.0±5.1） before and after IIEF-5 treatment， respectively （

0.01），Pre- and post-treatment of PCDDU measured mean plaque size was 0.23（0.09~0.54）cm

0.23（0.09~0.54）cm

，with no statistically different change in improvement value （

= 0.189）. Four cases had no penile camptodactyly， 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 （

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 follow-up， and no patient required subsequent surgery.

Conclusion

The results of this study show that visualizing the electrophysiological diagnosis situation to set local and holistic combined treatment parameters， and treating PD by means of percutaneous 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 opening new avenues for PD treatment.

关键词

佩罗尼氏病TMT图电生理诊断经皮低频电刺激

Keywords

Peyronie’s diseaseTMT imageelectrophysiological diagnosispercutaneous low frequency electrical stimulation

references

张翼，燕铁斌，庄甲举，等译. 临床电生理治疗学（3版）［M］. 北京：人民军医出版社， 2011.

Zhang Y，Yan TB，Zhuang JJ，et al. Translation. Clinical electrophysiology （third edition）［M］.Lippincott Williams & Wilkins， 2011.

Wang Z， Chen Y， Chen C， et al. Pain management of surgical abortion using transcutaneous acupoint electrical stimulation： an orthogonal prospective study［J］. J Obstet Gynaecol Res， 2018， 44（7）： 1235-1242.

Reis BM， da Silva JB， Rocha APR.et al. Intravaginal electrical stimulation associated with pelvic floor muscle training for women with stress urinary incon-tinence： study protocol for a randomized controlled trial with economic evaluation［J］. Trials， 2021， 22 （1）：823.

邓春华，商学军，王忠，等. 电生理适宜技术在男科疾病诊疗中的应用中国专家共识［J］.中华男科学杂志， 2022， 8（4）：366-377.

Deng CH， Shang XJ， Wang Z， et al. Chinese expert consensus on the application of electrophysiological techniques in the diagnosis and treatment of andrology diseases［J］. Natl J Andr， 2022， 8（4）： 366-377.

Lue TF. Peyronie’s disease： an anatomically-based hypothesis and beyond［J］. Int J Impotence Res， 2002， 14（5）： 411-413.

Mulhall JP， Creech SD， Boorjian SA， et al. Subjective and objective analysis of the prevalence of Peyronie’s disease in a population of men presenting for prostate cancer screening［J］. J Urol， 2004， 171（6 Pt 1）： 2350-2353.

Al-Thakafifi S， Al-Hathal N. Peyronie’s disease： a literature review on epidemiology，genetics， pathophysiology， diagnosis and work-up［J］. Transl Androl Urol， 2016， 5（3）： 280-289.

El-Sakka AI. Prevalence of Peyronie’s disease among patients with erectile dysfunction［J］. Eur Urol， 2006， 49（3）： 564-569.

El-Sakka AI， Tayeb KA. Peyronie’s disease in diabetic patients being screened for erectile dysfunction［J］. J Urol， 2005， 174（3）： 1026-1030.

Gelbard MK， Dorey F， James K. The natural history of Peyronie’s disease［J］. J Urol， 1990， 144（6）： 1376-1379.

Torres-Rosas R， Yehia G， Pea G， et al．Dopamine mediates vagal modulation of the immune system by electroacupuncture［J］. Nat Med， 2014， 20（3）： 291-295.

迟戈，马艳彬，李非，等. 中低频电疗法的临床应用［J］.中国医疗器械信息， 2010，16（11）： 26-27； +72.

Chi G， Ma YB， Li F， et al. Clinical application of low and medi-um frequency electrotherapy［J］. Med dev infor Chin， 2010， 16（11）： 26-27；+72.

Han JS. Acupuncture： neuropeptide release produced by electrical stimulation of different frequencies［J］. Trends Neurosci， 2003， 26（1）： 17-22.

Akkus E， Carrier S， Baba K， et al. Structural alterations in the tunica albuginea of the penis： impact of Peyronie’s disease， ageing and impotence［J］. Br J Urol， 1997， 79（1）： 47-53.

El-Sakka AI， Hassan MU， Nunes L， et al. Histological and ultrastructural alterations in an animal model of Peyronie’s disease［J］. Br J Urol， 1998， 81（3）： 445-452.

El-Sakka AI， Hassoba HM， Pillarisetty RJ， et al. Peyronie’s disease is associated with an increase in transforming growth factor beta protein expression［J］. J Urol， 1997， 158（4）： 1391-1394.

El-Sakka AI， Hassoba HM， Chui RM， et al. An animal model of Peyronie’s-like condition associated with an increase of transforming growth factor beta mRNA and protein expression［J］. J Urol， 1997， 158（6）： 2284-2290.

Mateus M， Ilg MM， Stebbeds WJ， et al. Understanding the role of adenosine receptors in the myofifibroblast transformation in Peyronie’s disease［J］. J Sex Med， 2018， 15：947-957.

Ilg MM， Mateus M， Stebbeds WJ， et al. Antififibrotic synergy between phosphodiesterase type 5 inhibitors and selective oestrogen receptor modulators in Peyronie’s disease models［J］. Eur Urol， 2019， 75：329-340.

Milenkovic U， Ilg MM， Zuccato C， et al. Simvastatin and the rho-kinase inhibitor Y-27632 prevent myofifibroblast transformation in Peyronie’s diseaseederived fifibroblasts via inhibition of YAP/TAZ nuclear translocation［J］. BJU Int， 2019， 123：703-715.

刘晓丹，冯洁玲，王嘉敏，等.盆底神经肌肉电刺激治疗对中重度宫腔粘连术后子宫内膜修复的疗效评估［J］. 中山大学学报（医学科学版）， 2022， 43（1）： 140-145.

Liu XD， Feng JL， Wang JM， et al. Effect of pelvic floor neuromuscular electrical stimulation on endometrial repair after the surgery of moderate to severe intrauterine adhesion［J］. J Sun Yat-sen Univ （Med Sci）， 2022， 43（1）： 140-145.

Sundaram PM， Rangharajan KK， Akbari E， et al. Direct current electric field regulates endothelial permeability under physiologically relevant fluid forces in a microfluidic vessel bifurcation model［J］. Lab Chip， 2021， 21（2）： 319-330.

Vernet D， Ferrini MG， Valente E， et al. Effect of nitric oxide on the differentiation of fibroblasts into myofibroblasts in the Peyronie’s fibrotic plaque and in its rat model［J］. Nitric Oxide， 2002， 7（4）： 262-276.

Liu K， Wang Z， Liu Y， et al. An electrophysiological technique to accurately diagnose and treat erectile dysfunction［J］. J Vis Exp， 2022， doi：10.3791/63851http://dx.doi.org/10.3791/63851.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

暂无数据