原发性早泄临床治疗的选择及疗效分析

发布时间：2018-03-30 22:21

本文选题：原发性早泄　切入点：阴茎背神经离断术　出处：《郑州大学》2016年硕士论文

【摘要】：研究背景及目的流行病学调查显示早泄在成年男性中的发病率为30%~40%,在男性性功能相关疾病中位列第一,而在以往勃起功能障碍是男性性功能疾病中发病率最高的疾病。近年来早泄已经跃居成为了男性性功能疾病的首要问题。据统计,75%的男性一生中出现过不同程度的早泄,造成了很多夫妻间的性生活不和谐,对患者的身心健康造成严重的影响。因此,早泄已经成为了泌尿男科医生面临的一个重要且亟待解决的临床课题,迫切的需要我们找到更加有效、更加易于患者接受的治疗方法解决早泄问题。近年来随着早泄的遗传学、分子神经生物学及内分泌学病因研究日趋增多,以及射精生理机制及早泄发病机制的认识日趋成熟,基于原发性早泄的神经生理学原因,选择性5-羟色胺再摄取抑制剂(SSRIs)对原发性早泄疗效确切,临床研究报道其有效率在63%左右。早泄的神经病理性病因的研究结果显示,早泄患者比正常人群的阴茎头要更加敏感或阴茎头感觉神经兴奋性更高,射精阈值更低。临床上采取降低阴茎龟头敏感度的治疗方法来提高射精阈值延迟射精,局部麻醉药物的有效率在60%以上;手术治疗多采用阴茎背神经离断术,阴茎系带埋线法,其实际疗效并不及国内相关文献报道的有效率。本研究主要是通过分析目前治疗原发性早泄的不同方法,对比分析各种方法的安全性和有效性。方法自2013年6月至2015年11月于郑州大学第一附属医院男科就诊的早泄患者中依据问卷调查、体格检查、自我IELT估测值诊断为原发性早泄患者228例。其中改良式阴茎背神经离断术患者87例,复方利多卡因乳膏患者61例,盐酸达泊西汀患者80例。所有原发性早泄患者在治疗1月后密切随访并连续记录三次阴道内射精潜伏期变化并评价疗效。结果改良式阴茎背神经离断术治疗87例患者,治疗前后IELT分别为1.13±0.50 min和2.58±2.44min,差异有统计学意义(P0.05),术后IELT大于3分钟25例,有效率28.7%;复方利多卡因乳膏治疗组61例,治疗前后IELT分别为1.14±0.55min和5.12±4.42min,差异有统计学意义(P0.01),治疗后IELT大于3min者37例,有效率65.6%;按需口服盐酸达泊西汀30mg患者80例,治疗前后IELT分别为1.11±0.52min和4.77±4.27min,差异有统计学意义(P0.01),治疗后IELT大于3min者49例,有效率61.3%。结论改良式阴茎背神经离断术是一种侵入性且不可逆的治疗手段,有效率并不及国内相关文献报道的水平,应慎重选择此手术;外用利多卡因乳膏与按需服用盐酸达泊西汀片有效率相当,但盐酸达泊西汀并不影响患者勃起功能及性快感,不良反应少,耐受性及依从性高。
[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 卤0.50 min and 2.58 卤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 卤0.55min and 5.12 卤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 卤0.52min and 4.77 卤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.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R698

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