精囊囊肿的临床诊治分析

Diagnosis and treatment of seminal vesicle cyst

目的提高对精囊囊肿的认识，以利于正确诊断和有效治疗。方法对5例精囊囊肿患者的诊断和治疗情况进行了回顾性总结。3例患者临床表现以血精最为多见，其次为膀胱刺激症状和会阴部不适或疼痛。行直肠指检、B超、CT及MRI等进行诊断。肿物大小为3．8cm×3．0cm×2．6cm-9．6am×5．2cm×5．0cm，5例均经病理证实。结果患者均行手术治疗，其中行开放精囊囊肿切除术2例，腹腔镜下精囊切除术3例。5例均治愈出院。除外1例患者术后出现同侧输尿管损伤治愈外，均无其他并发症的发生。随访5例患者（1例失访）1个月至10年，临床症状均消失，复查B超或CT均未见囊肿复发。结论对血精和难以解释的膀胱刺激症状或尿道生殖系的主诉要考虑患有本病可能；直肠指检、影像学检查为精囊囊肿诊断的主要手段。腹腔镜下精囊囊肿切除术具有良好的效果。

Objective To deepen the understanding of patients with seminal vesicle cyst to facilitate its correct diagnosis and treatment. Methods Five patients with seminal vesicle cysts were treated during January 1996 to May 2010. Their symptoms, diagnostic results, treatments and outcomes were analyzed retrospectively. Their mean age at diagnosis was 35 years old （ range ： 20 - 45 ）. The symptoms included hematospermia （ n = 3 ）, urinary frequency （ n = 3 ）, perineal malaise （ n = 4 ）, infertility （ n = 3 ）, postejaculation pain （ n = 3 ） , scrotal pain （ n = 3 ） and dysuria （ n = 1 ）. Cyst was palpable on digital rectal examination in 4 patients. All underwent intravenous urography and cystoscopy. Others received the examinations of ultrasonography, computed tomography （CT） scanning, magnetic resonance imaging （MRI） and vasovesiculography. The size range of masses was from 3.8 cm × 3.0 cm ×2. 6 cm - 9.6 cm× 5.2 cm×5.0 cm. Final open operations consisted of vesiculectomy （ n = 2 ） and laparoscopic excision of seminal vesical cyst （n = 3）. Results The post-operative course was uneventful except in 1 patient with damaged ureters. All patients stayed symptom-free after open surgery. Conclusion Seminal vesicle cysts are rare but should be considered in males with hematospermia and otherwise inexplicable bladder irritation symptoms, perineal discomforts or other genitourinary complaints of unknown etiology. The diagnostic modalities consist of digital rectal examination, transrectal and abdominal ultrasonography, CT scan or Mill. Laparoscopic excision offers excellent outcomes.