经尿道电切联合精囊镜射精管扩张术治疗苗勒管囊肿

Transurethral electrotomy combined with seminal vesiculoscopy ejaculatory duct dilatation in treating patients with Müllerian duct cyst

目的:探讨经尿道囊肿电切术联合精囊镜下射精管扩张术治疗苗勒管囊肿的可行性和疗效。方法:2009—2012年收治12例因苗勒管囊肿而梗阻引起的无精子症患者,患者均经精液分析(包括精液的量、p H值、果糖的测定)、直肠指检、直肠超声检查,盆腔磁共振成像、睾丸穿刺活检诊断的,采用经尿道电切联合经尿道精囊镜下射精管扩张术对患者进行治疗。术后随访12个月。结果:所有患者完成手术,患者精液量均增多,精液中出现精子,1年内精液分析连续3次正常。患者术后精液量和精浆果糖明显高于术前(均P<0.05)。3例患者配偶术后9~12个月怀孕。4例患者术后1年复查精囊腺明显缩小。结论:经尿道电切联合精囊镜下射精管扩张术可成为临床治疗伴有射精管梗阻症状的前列腺苗勒管囊肿的有效方法。

Objective: To evaluate the feasibility and efficacy of transurethral electrotomy combined with seminal vesiculoscopy ejaculatory duct dilatation in treating patients with Müllerian duct cyst. Methods: We retrospectively analyzed 12 infertile men due to Müllerian duct cyst between 2009 and 2012. They were diagnosed by semen analysis(including quantity of semen, p H and fructose), digital rectal examination, transrectal ultrasonography, magnetic resonance images and aspiration biopsy when necessary. All patients were treated by transurethral electrotomy combined with seminal vesiculoscopy ejaculatory duct dilatation and were followed up for 12 months. Results: A significant improvement of semen quality was achieved after surgery and the sperms could be seen. The patients’ semen was analyzed for 3 times in 12 months and the results were normal. Semen volume and pure berries of the patients were increased after the operation compared with those before the operation(P<0.05). Spontaneous pregnancies were achieved in 3 patients 9–12 months after surgery. Four patients’ seminal vesicle became smaller obviously. Conclusion: Transurethral electrotomy combined with seminal vesiculoscopy ejaculatory duct dilatation is effective and safe for the treatment of Müllerian duct cyst accompanied with ejaculatory duct obstruction.