输尿管镜下钬激光内切开治疗远端精道疾病

Holmium laser incision through ureteroscopy for distal seminal tracts diseases

目的：对输尿管镜下钬激光内切开与单纯输尿管镜精道检查治疗远端精道疾病疗效进行对比分析.方法：回顾分析2003年12月~2012年8月远端精道疾病患者71例,血精57例,单纯射精管囊肿8例,无精症6例.均行精液分析、经直肠前列腺、精囊彩超检查,部分患者行盆腔CT 或 MRI 检查.结果：54例血精患者(3例未进入),24例行单纯输尿管镜精道检查,30例行输尿管镜下钬激光内切开.均有不同程度的射精管开口狭窄或梗阻；7例单纯射精管口囊肿,行钬激光囊肿去顶减压术.6例无精症患者均表现为射精管开口梗阻,伴精囊扩张,行钬激光内切开术.术后随访,行单纯输尿管镜精道检查患者中,1例术后6个月、1例术后8个月血精复发,再次手术,发现射精管开口狭窄,行钬激光内切开术,术后血精消失.7例有前列腺炎的单纯射精管口囊肿患者,术后3个月复查,3例治愈,3例好转,1例无效.6例无精症患者,2例患者配偶分别于术后7、14个月妊娠,4例术后1~3个月内即可查及精子,1例患者术后随访12个月未发现精子.3例术后出现附睾炎,经抗感染、对症治疗,好转.未发生逆行射精、尿失禁或直肠损伤等并发症.结论：输尿管镜钬激光内切开较单纯输尿管镜精道检查治疗远端精道疾病疗效更好,是否值得临床推广应用,还需进一步观察总结.

Objective:Toanalyzetheefficacyofholmiumlaserincisionthroughureteroscopyandsimpleureteros-copy treat ment for distal se minal tracts diseases .Methods:We retrospectively analyzed 71 cases of distal se minal tracts diseases ,including 57 cases of he matosper mia ,8 cases of simple ejaculatory duct cysts ,and 6 cases of azoospermia.All the patients underwent semen analysis,transrectal ultrasonography,and seminal vesicle ultra-sonography ,and so me patients given pelvic CT or MRI .Results:In 54 cases of he mosper mia ,24 cases received si m-pleureteroscopy,and 30 cases were given holmium laserincision through ureteroscopy.Varying degrees of ejaculato-ry duct stenosis or obstruction were observed:7 cases of ejaculatory duct cysts and 6 cases of azoosper mia were sub-jected to hol miumlaser .During the postoperative follow-up ,2 cases experienced recurrence 6 or 8 months later in 24 cases of simple ureteroscopy .In 7 cases of prostatitis with simple ejaculatory duct cysts ,3 cases were cured ,3 cases i mproved ,and 1 case invalid .In 6 cases of azoosper mia ,2 patients'spouses were pregnant 7 or 14 months after sur-gery.Sperms weredetectedin4cases within1to3 monthsaftersurgery.Epididymitisoccurredin3cases.Nosuch complications as retrograde ejaculation,urinaryincontinence or rectal injury were observed postoperatively.Conclu-sions:The efficacy of hol miumlaser incision through ureteroscopy for distal seminal tracts diseases is better than simple ureteroscopy,whether it is worthy of clinical application needs further observation and summary.