经尿道精囊镜治疗顽固性血精的临床应用效果

Clinical efficacy of transurethral seminal vesiculoscopy in the treatment of refractory hematospermia

目的探讨精囊镜技术治疗顽固性血精的临床疗效。方法总结北京怀柔医院2018年1月至2022年6月50例因顽固性血精行经尿道精囊镜手术治疗的患者临床资料。手术方法:精囊镜经正常射精管开口或前列腺小囊途径进入精囊腺,予以0.9%氯化钠、庆大霉素冲洗精囊腔内血块或炎性物质,合并结石者予以钬激光碎石后取出或取石网篮直接取出,合并息肉者予以切除。术后留置导尿管。结果50例患者均一次手术成功。手术时间45~75 min,平均62.36 min。12例经射精管自然开口进镜,38例经前列腺小囊戳孔进镜。所有患者术中均见不同程度的精囊慢性炎症表现,其中45例精囊内积血,合并精囊结石16例,精囊息肉2例,前列腺黏膜出血3例。术后10例会阴区疼痛不适,4例发生膀胱刺激症状,对症治疗后症状均消失。随访6~20个月,6例出现血精复发,未进一步诊治。结论经尿道精囊镜治疗顽固性血精创伤小、临床疗效满意,是治疗顽固性血精的有效手术方法。

Objective To investigate the clinical effect of the seminal vesiculoscopy technique in the treatment of recalcitrant hematospermia.Methods The clinical data of 50 patients with refractory hematospermia who underwent transurethral seminal vesicle surgery from January 2018 to June 2022 at Beijing Huairou Hospital were collected and summarized.The procedure was performed by entering the seminal vesicle gland through the normal ejaculatory duct opening or the small prostatic utricle.Blood clots or inflammatory substances in the seminal vesicle lumen were washed with 0.9%sodium chloride and gentamicin.The calculus was removed after holmitim laser lithotripsy or directly removed with a stone basket,and the polyps were also removed.A catheter was left in place after surgery.Results All 50 patients were operated on successfully in one operation with an operation time of(62.36±11.10)min.A total of 12 patients underwent endoscopy through the natural opening of the ejaculatory duct,and 38 patients underwent endoscopy through the prostatic utricle.Chronic inflammation of the seminal vesicles was detected during the operation,including 45 cases of seminal vesicle hemorrhage,16 cases of seminal vesicle calculi,2 cases of seminal vesicle polyps,and 3 cases of prostatic mucosal bleeding.Ten patients had pain and discomfort in the perineal area,and 4 patients had bladder irritation symptoms after the operation,all of which disappeared after symptomatic treatment.Dtiring the follow-up period of 6~20 months,6 cases had recurrence of hematospermia without further diagnosis and treatment.Conclusion Transurethral seminal vesicles are an effective surgical method for the treatment of recalcitrant hematospermia with little traioma and satisfactory clinical efficacy.