丁黎

摘要：Peyronie病（PD）确切病因尚不明确，目前被认为是一些易感人群因为阴茎白膜的损伤（重复的小血管损伤或创伤）导致其创伤修复障碍，并最终形成纤维斑块，导致阴茎畸形、疼痛、插入困难及勃起功能障碍等。PD不仅是患者身体上的一种畸形，更是对其心理上的一种毁灭性打击。由于目前对PD病理生理的不完全理解及对该病的一些误解导致其治疗进展受限，使PD成为一种具有挑战性的疾病。根据目前的一些相关研究，绝大多数口服药物因疗效不确切而不被推荐常规使用，一些局部药物治疗及外力治疗等疗效尚存争议，而作为矫正阴茎畸形金标准的手术治疗则有导致阴茎缩短、术后ED的风险等，如何选择一种合适的治疗方案成为了困扰患者及泌尿外科医生的难题。本文整理美国泌尿学协会（AUA）和欧洲泌尿学协会（EAU）治疗PD的最新指南以及国内外治疗PD的相关研究，主要对PD的相关危险因素、流行病学及临床诊治进行综述，旨在为临床治疗PD提供参考。

关键词：Peyronie病;阴茎畸形;流行病学;阴茎白膜

Abstract：The exact cause of Peyronie's disease （PD） is unclear and is currently considered to be a susceptible population due to penile tunica albuginea （repetitive small vessel injury or trauma） resulting in a wound repair disorder that eventually leads to fibrous plaque， leading to penile malformations， pain， difficulty in insertion， and erectile dysfunction. PD is not only a deformity on the patient's body， but also a psychologically devastating blow. Due to the current incomplete understanding of the pathophysiology of PD and some misunderstanding of the disease， its treatment progress is limited， making PD a challenging disease. According to some current related research， the vast majority of oral drugs are not recommended for routine use because of inaccurate efficacy. Some local drug treatments and external treatments are still controversial， and surgical treatment as a standard for correcting penile malformation leads to penis. Shortening， the risk of postoperative ED， etc. How to choose a suitable treatment plan becomes a problem that plagues patients and urologists. This article reorganizes the latest guidelines for the treatment of PD by the American Association of Urology （AUA） and the European Association of Urology （EAU）， as well as related studies on PD treatment at home and abroad， focusing on the related risk factors， epidemiology and clinical diagnosis and treatment of PD. Provide a reference for clinical treatment of PD.

Key words：Peyronie disease;Penile malformation;Epidemiology;Penis white film

Peyronie病（PD）是1743年由Francois Gigot de la Peyronie首次提出，因此该病以其命名。PD目前被认为是由于易感人群阴茎白膜损伤（重复的小血管损伤或创伤）后的创伤修复障碍，导致Ⅰ型到Ⅲ型胶原、纤维蛋白和紊乱的弹性纤维过度堆积而形成的纤维斑块[1，2]，因此阴茎白膜创伤被认为是该病发生的必要条件[3，4]。另外氧自由基、氧化应激、NO、肌成纤维细胞、TGF-β1和纤维化基因表达均在PD的发展中发挥关键作用[5]。……