超声引导下精囊穿刺置管治疗顽固性血精

TRUS-Guided Interventional therapy on persistent hematospermia

目的：探讨经直肠超声引导下经会阴精囊穿刺置管连续滴注抗生素在治疗顽固性血精的价值。方法：25例临床诊断为顽固性血精的患者，在经直肠超声实时引导下行经会阴精囊穿刺置管术，在取得精囊液后留置导管，经导管连续滴注抗生素一周。结果：25例患者均一次穿刺置管成功，其中23例完成一周治疗，2例由于导管滑脱而提早拔管。治疗后随访6个月～2年，23例血精消失（92．0％），2例复发，其中1例为提早拔管者。结论：超声引导下经会阴精囊穿刺置管滴注抗生素是一种治疗顽固性血精安全而有效的方法。

Objective：To evaluate the value of transperineal seminal vesicle puncture under TRUS guidance and continuous transcatheter antibiotics instillation for the treatment of persistent hematospermia. Methods： Twentyfive patients with persistent hematospermia were included in the study, aged 43.2±21.3 years, and with a course of the disease 23.2±25.3 months. After the expressed prostatic secretion by prostatic massage was cultured, all 25 patients were detected by TRUS and treated by transperineal seminal vesicle puncture under TRUS guidance with continuous transcatheter antibiotics instillation for 7 days. Results： Abnormal images were found in the seminal vesicle and/or ejaculatory duct in 18 cases, including seminal vesicle and/or ejaculatory duct dilation, calculi of seminal vesicle ,seminal vesicle wall thickening or calcification and ejaculatory duct cyst. All patients were successfully catheterized, 23 patients completed the treatment for one week, two cases had their catheter extubated early. All patients were followed up for 6-24 months. Hematospermia is disappeared in, 23 cases（92.0%） and relapsed in the other 2. Conclusions：TRUS-guided Transperineal seminal vesicle puncture and continuous transcatheter antibiotics instillation was an effective method for the treatment of persistent hematospermia.