本文選題：原發(fā)性早泄　切入點(diǎn)：陰莖背神經(jīng)離斷術(shù)　出處：《鄭州大學(xué)》2016年碩士論文

【摘要】：研究背景及目的流行病學(xué)調(diào)查顯示早泄在成年男性中的發(fā)病率為30%~40%,在男性性功能相關(guān)疾病中位列第一,而在以往勃起功能障礙是男性性功能疾病中發(fā)病率最高的疾病。近年來早泄已經(jīng)躍居成為了男性性功能疾病的首要問題。據(jù)統(tǒng)計(jì),75%的男性一生中出現(xiàn)過不同程度的早泄,造成了很多夫妻間的性生活不和諧,對患者的身心健康造成嚴(yán)重的影響。因此,早泄已經(jīng)成為了泌尿男科醫(yī)生面臨的一個(gè)重要且亟待解決的臨床課題,迫切的需要我們找到更加有效、更加易于患者接受的治療方法解決早泄問題。近年來隨著早泄的遺傳學(xué)、分子神經(jīng)生物學(xué)及內(nèi)分泌學(xué)病因研究日趨增多,以及射精生理機(jī)制及早泄發(fā)病機(jī)制的認(rèn)識日趨成熟,基于原發(fā)性早泄的神經(jīng)生理學(xué)原因,選擇性5-羥色胺再攝取抑制劑(SSRIs)對原發(fā)性早泄療效確切,臨床研究報(bào)道其有效率在63%左右。早泄的神經(jīng)病理性病因的研究結(jié)果顯示,早泄患者比正常人群的陰莖頭要更加敏感或陰莖頭感覺神經(jīng)興奮性更高,射精閾值更低。臨床上采取降低陰莖龜頭敏感度的治療方法來提高射精閾值延遲射精,局部麻醉藥物的有效率在60%以上;手術(shù)治療多采用陰莖背神經(jīng)離斷術(shù),陰莖系帶埋線法,其實(shí)際療效并不及國內(nèi)相關(guān)文獻(xiàn)報(bào)道的有效率。本研究主要是通過分析目前治療原發(fā)性早泄的不同方法,對比分析各種方法的安全性和有效性。方法自2013年6月至2015年11月于鄭州大學(xué)第一附屬醫(yī)院男科就診的早泄患者中依據(jù)問卷調(diào)查、體格檢查、自我IELT估測值診斷為原發(fā)性早泄患者228例。其中改良式陰莖背神經(jīng)離斷術(shù)患者87例,復(fù)方利多卡因乳膏患者61例,鹽酸達(dá)泊西汀患者80例。所有原發(fā)性早泄患者在治療1月后密切隨訪并連續(xù)記錄三次陰道內(nèi)射精潛伏期變化并評價(jià)療效。結(jié)果改良式陰莖背神經(jīng)離斷術(shù)治療87例患者,治療前后IELT分別為1.13±0.50 min和2.58±2.44min,差異有統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后IELT大于3分鐘25例,有效率28.7%;復(fù)方利多卡因乳膏治療組61例,治療前后IELT分別為1.14±0.55min和5.12±4.42min,差異有統(tǒng)計(jì)學(xué)意義(P0.01),治療后IELT大于3min者37例,有效率65.6%;按需口服鹽酸達(dá)泊西汀30mg患者80例,治療前后IELT分別為1.11±0.52min和4.77±4.27min,差異有統(tǒng)計(jì)學(xué)意義(P0.01),治療后IELT大于3min者49例,有效率61.3%。結(jié)論改良式陰莖背神經(jīng)離斷術(shù)是一種侵入性且不可逆的治療手段,有效率并不及國內(nèi)相關(guān)文獻(xiàn)報(bào)道的水平,應(yīng)慎重選擇此手術(shù);外用利多卡因乳膏與按需服用鹽酸達(dá)泊西汀片有效率相當(dāng),但鹽酸達(dá)泊西汀并不影響患者勃起功能及性快感,不良反應(yīng)少,耐受性及依從性高。
[Abstract]:Background and objective Epidemiological investigation showed that the incidence of premature ejaculation in adult men was 30%, and ranked first among male sexual function related diseases. In the past, erectile dysfunction was the highest incidence of male sexual dysfunction. In recent years, premature ejaculation has become the primary problem of male sexual dysfunction. According to statistics, 75% of men have experienced some degree of premature ejaculation in their lifetime. This has caused many couples to have a disharmonious sexual life, which has a serious impact on the physical and mental health of patients. Therefore, premature ejaculation has become an important and urgent clinical issue facing urologists. There is an urgent need for us to find more effective and more palliative treatments for premature ejaculation. In recent years, with the genetics of premature ejaculation, molecular neurobiology and endocrinology have been increasing. The physiological mechanism of ejaculation and the pathogenesis of premature ejaculation are becoming more and more mature. Based on the neurophysiological reasons of primary premature ejaculation, selective serotonin reuptake inhibitor (SSRIsa) is effective in the treatment of primary premature ejaculation. Clinical studies report that the effective rate is about 63%. The results of neuropathic etiology of premature ejaculation show that premature ejaculation patients are more sensitive or more excitatory to the head of penis than normal people. The effective rate of local anesthetic drugs was more than 60%. The actual curative effect is not as effective as reported in domestic literature. This study is mainly based on the analysis of the current treatment of primary premature ejaculation. Methods from June 2013 to November 2015, patients with premature ejaculation in Department of andrology, first affiliated Hospital of Zhengzhou University, were investigated by questionnaire and physical examination. There were 228 cases of primary premature ejaculation diagnosed by self-estimated value of IELT, including 87 cases of modified dorsal penile nerve dissection and 61 cases of compound lidocaine cream. There were 80 cases of dapoxetine hydrochloride. All the patients with primary premature ejaculation were followed up closely after one month of treatment, and the changes of the latent period of ejaculation were recorded three times in succession and the curative effect was evaluated. Results 87 patients were treated with modified dorsal penis nerve dissection. The IELT before and after treatment were 1.13 鹵0.50 min and 2.58 鹵2.44 minutes, respectively. The difference was statistically significant (P 0.05). The effective rate of IELT was more than 3 minutes in 25 cases, and the effective rate was 28.7in compound lidocaine cream group (61 cases). The IELT before and after treatment were 1.14 鹵0.55min and 5.12 鹵4.42 mins, respectively. The difference was statistically significant (P 0.01). After treatment, IELT was higher than 3min in 37 cases, and the effective rate was 65.60.There were 80 cases of 30mg treated with Dapoxetine Hydrochloride. The IELT before and after treatment was 1.11 鹵0.52min and 4.77 鹵4.27 mins, respectively. The difference was statistically significant (P 0.01). After treatment, IELT was higher than 3min in 49 cases, the effective rate was 61.3%. Conclusion modified dorsal penile nerve dissection is an invasive and irreversible treatment method. The effective rate is not up to the level reported in the relevant literature in China, so we should choose this operation carefully. The effective rate of topical lidocaine cream is comparable to that of dapoxetine hydrochloride on demand, but dapoxetine hydrochloride does not affect erectile function and sexual pleasure of patients. Less adverse reactions, high tolerance and compliance.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R698

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