静脉闭塞性勃起功能障碍的现代矫正方法

Александр Книгавко
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摘要

目的:探讨自体干细胞联合PRP治疗刺激静脉闭塞机制在静脉瘘手术切除中的远期疗效。材料与方法:对156例静脉闭塞性勃起功能障碍患者进行综合检查与治疗。其中112例(82.9%)为左侧或双侧精索静脉曲张。第一组86例近端静脉闭塞性勃起功能障碍患者,行阴茎深背静脉和静脉结扎术,并行泡沫耻骨切口Marmara手术。在第二组49例远端静脉闭塞性勃起功能障碍患者中,通过阴茎深背静脉导管栓塞深背静脉和圣托里尼丛静脉。为改善静脉闭塞机制,48例患者(1b组和2b组)在闭塞术中,每个海绵体注入100万个自体内皮干细胞和200万个自体成纤维干细胞,经血管生长因子激活后逆行注入结扎静脉(阴茎深背静脉和大静脉),并比较长期结果。结果:根据主观数据(IIEF问卷)- 2个月后手术治疗的有效性几乎相等,但在18个月后,1b和2b亚组(68.9%)和根据客观数据(阴茎多普勒造影无静脉漏),18个月后手术治疗的有效性分别为73.4%和91.4%。结论:自体(内皮细胞和成纤维细胞)干细胞在PRP治疗过程中改善了静脉闭塞机制,提高了静脉闭塞手术治疗VOED的效率和长期效果,为有这一问题的男性创造了一种有效的阴茎修复术替代方案。
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MODERN METHODS OF CORRECTION OF VEIN-OCCLUSIVE ERECTILE DYSFUNCTION
Aim: to study the long-term effectiveness of stimulation of the vein-occlusive mechanism by the addition of autologous stem cells and PRP therapy in the surgical removal of venous leak.Materials and Methods: comprehensive examination and treatment of 156 patients with vein-occlusive erectile dysfunction was carried out. Most of them – 112 (82.9%), – had left-sided or bilateral varicocele. In 86 patients of the first group with a proximal form of vein-occlusive erectile dysfunction, ligation of deep dorsal veins and veins of the penis and Marmara operation from a foam-pubic incision were performed. In 49 patients of the second group with a distal form of vein-occlusive erectile dysfunction, embolization of deep dorsal veins and veins of the Santorini plexus was performed through a conductor in the deep dorsal vein of the penis. To improve the venous occlusion mechanism, 1 million autologous endothelial stem cells and 2 millions autologous fibroblast stem cells were injected into each cavernous body, which were activated by vascular growth factor into the ligated veins (deep dorsal and large veins of the penis) in a retrograde direction during occlusive operations for 48 patients (groups 1b and 2b, respectively) and compared long-term results.Results: The effectiveness of surgical treatment according to subjective data (IIEF questionnaire) – after 2 months was almost equal, but after 18 months it was significantly higher in subgroups 1b and 2b (68,9% и 75,5) and according to objective data (no venous leakage with dopplerography of the penis), after 18 months in 73.4% and 91.4%, respectively.Conclusions: The use of autologous (endothelial and fibroblast) stem cells with the course of PRP therapy improves the veno-occlusive mechanism, increases the efficiency and long-term results of vein-occlusive surgeries for the treatment of VOED, creating an effective alternative to phalloprosthetics for men with this problem.
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