精囊镜技术治疗射精管不全梗阻性少弱精子症:8例报道

Transurethral seminal vesiculoscopy in treatment of oligoasthenozoospermia secondary incomplete ejaculatory duct obstruction: A report of 8 cases

目的:探讨精囊镜技术治疗射精管不全梗阻性少弱精子症的可行性和疗效。方法:回顾分析2018年3—9月北京大学第三医院男科采用精囊镜射精管扩张技术治疗8例射精管不全梗阻性少弱精子症患者的临床资料。术前常规行精液分析,激素测定,经直肠超声、盆腔MRI等检查。所有患者均由同一位经验丰富的主任医师实施手术,术后1年随访评估手术疗效。对于手术前后的参数改变采用t检验统计分析。结果:8例患者的平均年龄29岁,所有患者均行经尿道射精口探查切开术,平均手术时间32 min,术前经直肠超声检查提示射精管囊肿或苗勒管囊肿(Mullerian duct cyst)6例,前列腺钙化、双侧精囊扩张1例。盆腔MRI检查显示右侧精囊最大横径平均为33.60 mm(24.63~42.28 mm),左侧精囊最大横径平均为32.85 mm(25.91~44.89 mm),最大前后径平均为27.99 mm(21.36~33.12 mm),精囊腺管最大宽度平均为10.53 mm(5.93~19.39 mm)。患者中射精管囊肿5例、合并精囊出血2例、苗勒管囊肿1例。术后6个月复查精液量为(2.64±0.80)mL、精子密度为(49.76±8.50)×10^6/mL、(a+b级)精子活率为(25.76±6.48)%,分别较术前的(1.46±0.50)mL、(28.78±5.17)×10^6/mL和(2.88±0.93)%有明显改善(P<0.05)。2例患者在术后6个月随访时配偶自然受孕,8例患者术后未见逆行射精、尿失禁或直肠损伤等并发症。结论:精囊镜射精管扩张治疗射精管不全梗阻性少弱精子症技术可行,是治疗射精管不全梗阻性少弱精子症安全、有效的手段,但由于研究样本量较小,随访时间较短,且精囊镜术中的不确定性,仍需要大样本长时间随访研究以进一步证实。

Objective:To evaluate the utility of transurethral seminal vesiculoscopy with a slender ureteroscope in the treatment of severe oligoasthenozoospermia secondary incomplete ejaculatory duct obstruction(EDO).Methods:From March 2018 to September 2018,the clinical data of 8 patients with severe oligoasthenozoospermia secondary incomplete EDO treated by the technique of transurethral seminal vesiculoscopy in the Peking University Third Hospital Reproductive Center were analyzed.Preoperative routine included semen analysis,hormone determination,transrectal ultrasonography,pelvic magne-tic resonance examination and other examinations.All the patients were diagnosed with severe oligoasthenozoospermia secondary to incomplete EDO.All the patients were operated by the same surgeon with multiple cases of experience in transurethral surgery,and 1 year follow-up was conducted to evaluate the surgical effect.Results:The average age of the 8 patients was 29 years,and the average operation time was 32 min.Preoperative transrectal ultrasound indicated 6 cases of ejaculatory duct cyst or Mullerian cyst,1 case of prostate calcification and bilateral seminal vesicle dilatation.The average maximum transverse diameter of the right seminal vesicle in pelvic MRI was 33.60 mm(24.63-42.28 mm),the average maximum transverse diameter of the left seminal vesicle was 32.85 mm(25.91-44.89 mm),the ave-rage maximum antero-posterior diameter was 27.99 mm(21.36-33.12 mm),the average maximum width of the seminal vesicle duct was 10.53 mm(5.93-19.39 mm).There were 5 cases of ejaculatory duct cyst,2 cases of seminal vesicle hemorrhage,and 1 case of Mullerian cyst.The semen volume[(2.64±0.80)mL],the sperm concentration[(49.76±8.50)×10^6/mL],and the motility(grade a+b)[(25.76±6.48)%]in postoperation were significantly higher than those in preoperation[(1.46±0.50)mL,(28.78±5.17)×10^6/mL,and(2.88±0.93)%,P<0.05].Two patients conceived naturally during the follow-up of 6 months after surgery.There were no severe complications,such as retrograde ejaculation,urinary incontinence or rectal injury.Conclusion:The technique of transurethral seminal vesiculoscopy is safe and effective for treating severe oligoasthenozoospermia secondary to incomplete EDO.However,due to the small sample size of this study,short follow-up time,and the uncertainty in seminal vesicle surgery,it still needs to be further confirmed by long-term follow-up studies with large samples.