输尿管镜精囊镜检在顽固性血精诊疗中的应用

Transurethral Seminal Vesiculoscopy in Diagnosis and Treatment of Persistent Hemospermia

目的评价经前列腺小囊输尿管镜下精囊镜检查在顽固性血精的诊断及治疗中的作用。方法回顾性分析2011年1月～2012年6月间收治的11例顽固性血精患者的临床资料,均在完善前列腺和精囊腺相关检查(如经直肠前列腺+精囊腺彩超、MRI等)后,采用STORZ F6/7.5输尿管镜,经前列腺小囊行输尿管镜下精囊镜检查。结果 11例患者均顺利完成手术。手术时间16～38 min,平均(25.1±9.3)min。单纯精囊壁粘膜炎症性充血、散在出血点6例(54.5%);精囊粘膜炎症性改变并腔内结石2例(18.2%);射精管出血2例(18.2%),精囊小囊肿1例(9.1%);均进行对症治疗。术后随访3个月,1例(9.1%)患者术后再次出现血精。术后均未出现附睾炎、逆行射精、尿道损伤等并发症。结论经前列腺小囊输尿管镜下精囊镜检查,能直视下检查精囊腔内情况,有助于明确顽固性血精的病因,并针对病因进行治疗,并发症少,对于顽固性血精具有很好的应用价值。

Objective To evaluate the role of trans-utricular seminal vesiculoscopy in diagnosis and treatment of refractory hemospermia. Methods From January 2011 to June 2012, a total of 11 patients with persistent hematospermia underwent trans-utricular seminal vesiculoseopy. After transrectal ultrasonog- raphy and magnetic resonance imaging, trans-ntricular seminal vesiculoscopy was performed in all patients by using a F6/7.5 rigid ureteroscope. Results All 11 patients were accomplished the surgery successfully with the average operative duration of （21.1± 9.3 ） minutes （ranged from 16 to 38 minutes）. Among them, simple mueosal inflammatory hyperemia and scattered bleeding point was in 6 cases, tuniea mucosa vesicular seminal inflammation combined intracavitary calculi in 2 cases, hemorrhage in ejaeulatory ducts in 2 cases and small cyst of seminal vesicles in 1 case. All cases were received symptomatic treatment during the surgery and fol- lowed up for 3 months after the operation. Hematospermia was subsided in 10 cases and recurred in 1 patient. There were no complications such as epididymitis, retrograde ejaculation and urethral injury. Conclusion Trans-utricular seminal vesiculoscopy can be performed easily with few complications, and it is an effective di- agnosis and therapeutic approach for persistent hematospermia.