经直肠超声引导下微型可视肾镜在顽固性血精诊疗中的应用

Diagnosis and treatment of intractable hematospermia using a mini-nephroscope under transrectal ultrasound guidance

目的探讨经直肠超声(transrectal of ultrasound,TRUS)引导下微型可视肾镜在诊疗顽固性血精中的有效性及安全性。方法收集本院2018年1月至2019年6月收治的14例顽固性血精患者临床资料,术中检查发现难以寻找射精管开口,进入前列腺小囊内见侧后壁5点或7点钟方向半透明的膜性区域不明显,不适合行经射精管自然通道检查,从而在TRUS引导下采用可视肾镜行小囊侧后壁穿刺进镜,分析经超声引导下微型可视肾镜诊疗效果。结果14例患者均完成精囊镜检,精囊进镜成功率为100%。手术时间35(18~95)min,住院时间3.6(3~5)d,其中精囊内陈旧性血凝块10例,合并精囊结石4例,精囊囊肿2例,精囊内炎性息肉1例,未见明显异常者1例,采用冲洗、扩张、钬激光囊肿去顶减压、碎石取石、息肉切除等治疗。随访6~24个月,术后2~4周血精消失,其中6例射精痛、盆底不适症状患者明显缓解。1例术后6个月血精复发,保守治疗后痊愈。术后1例出现精液稀薄、量多。无直肠损伤、附睾炎、逆行射精等并发症。结论TRUS引导下微型可视肾镜用于诊疗顽固性血精,可精准穿刺进镜,提高手术成功率,避免反复穿刺,降低手术损伤,安全有效,值得临床推广。

Objective To investigate the efficacy and safety of mini-nephroscope under transrectal ultrasound guidance for treatment of intractable hematospermia.Methods We retrospectively analyzed the clinical data of 14 patients with intractable hematospermia undergoing surgical treatment between January,2018 and June,2019.During the surgery,the opening of the ejaculatory duct was difficult to identify in these patients,and the translucent membranous area at 5 or 7 o’clock in the lateral posterior wall of the prostate was not obvious after entering the seminal vesicle,which did not allow natural orifice surgery via the ejaculatory duct.Under TRUS guidance,the lateral posterior wall of the seminal vesicle was punctured for entry of the mini-nephroscope.Results All the 14 patients completed seminal vesicle examinations and the success rate of nephroscope entry via the seminal vesicle was 100%.The operation time was 35(18~95)min,and the hospital stay of the patients was 3.6(3~5)d.Ten patients were found to have old blood clot,4 had calculi,2 had cysts,and 1 had inflammatory polyp in the seminal vesicle;1 patient did not show obvious abnormality in the seminal vesicle.The patients were treated by seminal vesicle flushing,expansion,holmium laser cyst decapitation and decompression,lithotripsy and polypectomy.The patients were followed up for 6~24 months,during which the symptom of hemospermia disappeared 2~4 weeks after the operation in all the patients,and 6 patients reported significant relief of ejaculation pain and pelvic floor discomfort.One patient experienced recurrence of hemospermia 6 months after the operation and was cured after conservative treatment.One patient had thin and abundant semen.None of the patients were found to have rectal injury,epididymitis,retrograde ejaculation or other complications.Conclusion TRUS-guided nephroscopy using a mini-nephroscope is safe and effective for treatment of intractable hematospermia and allows accurate puncture of the seminal vesicle to improve the success rate of the operation,avoid repeated puncture,and reduce the surgical complications.