不同入路精囊镜治疗顽固性血精症的疗效评价

Evaluation of therapeutic effect of different approaches of seminal vesiculoscopy on refractory hematospermia

目的:比较经前列腺小囊与经射精管开口进镜的精囊镜探查疗效。方法:回顾性分析2015年6月至2022年12月间我院收治的顽固性血精症74例,根据精囊镜入路不同分为A组29例和B组45例,A组精囊镜入路为经前列腺小囊内开窗进入,B组精囊镜入路为经自然腔道进入。记录并评估A、B组治疗前、后3个月后精液中红细胞数、视觉模拟评分法(VAS)评分、国际勃起功能指数问卷表-5(IIEF-5)评分、性功能评价表(CIPE)评分及汉密尔顿焦虑量表(HAMA)评分。结果:纳入的74例患者均顺利完成手术。B组相比A组患者术后3月血精改善情况优[(15.24±9.18)个/HPF vs.(19.52±8.06)个/HPF],VAS评分[(2.69±0.18)分vs.(3.67±0.27)分]和HAMA评分[(7.07±4.56)分vs.(9.79±5.56)分]低,IIEF-5评分[(18.62±2.66)分vs.(16.52±3.94)分]和CIPE评分[(36.87±4.00)分vs.(34.38±5.57)分]明显高,差异均具有统计学意义(P<0.05)。结论:经射精管开口自然腔道精囊镜探查在血精症状缓解、勃起和射精功能恢复以及缓解精神焦虑方面均优于经前列腺小囊内开窗进镜精囊镜探查。

Objective:To compare the experience and efficacy of seminal vesiculoscopy through prostatic vesicle and through ejaculatory duct opening.Methods:A retrospective analysis was performed on 74 eligible patients with refractory hematospermia admitted from June 2015 to December 2022.According to the approach of admission,74 patients were divided into group A and Group B.The seminal vesicle-guided approach in group A was via prostatic vesicle,whereas the seminal vesicle-guided approach in group B was via ejaculatory duct opening.Seminal erythrocyte counts,visual analogue scale(VAS)scores,international index of erectile function-5(IIEF-5),Chinese index of sexual function for premature ejaculation(CIPE)scores,and Hamilton anxiety scale(HAMA)scores were recorded and assessed before and 3 months after treatment in groups A and B.Results:All 74 enrolled patients finished the surgery successfully.Compared with Group A,Group B has better seminal erythrocyte counts[(15.24±9.18)HPF vs.(19.52±8.06)HPF],lower VAS[(2.69±0.18)vs.(3.67±0.27)]and HAMA[(7.07±4.56)vs.(9.79±5.56)]scores,and significantly higher IIEF-5[(18.62±2.66)vs.(16.52±3.94)]and CIPE[(36.87±4.00)vs.(34.38±5.57)]scores at 3 months after surgery,and the differences were statistically significant(P<0.05).Conclusion:Seminal vesiculoscopy through ejaculatory duct opening is superior to that through prostatic vesicle in relief of hemospermia syndrome,the recovery of erectile and ejaculatory function,and the alleviation of mental anxiety.