经尿道精囊镜诊治顽固性或复发性血精162例临床资料分析

Transurethral seminal vesiculoscopy for refractory or recurrent hemospermia:Clinical analysis of 162 cases

目的:分析经尿道精囊镜诊治顽固性或复发性血精的可行性和有效性。方法:回顾分析2007年1月至2010年7月采用经尿道精囊镜诊治的顽固性或复发性血精患者162例,患者年龄19～76岁,血精病史3个月至11年,术前均因血精就诊,均行血清PSA、经直肠前列腺、精囊腔内B超以及盆腔CT或MRI检查,常规抗生素治疗4周效果欠佳或反复发作者,收治入院,行经尿道精囊镜检查。结果:全部病例术中均可见一侧或双侧精囊中暗红色或紫红色胶浆样物质和炎性改变,所有患者均取小块组织活检,病理结果回报为精囊黏膜慢性炎性改变,15例患者另可见射精管或精囊中结石;术后平均随访时间为21.7个月(12～29个月),92.6%(150/162)的患者在术后随访中经过1～15次射精后,血精消失或减轻。1例(67岁)患者因无射精活动而无法判断,7例患者术后血精消失超过3个月后复发,4例患者术后血精症状无减轻。1例患者术后发生急性双侧附睾炎,所有病例术后未见逆行射精、尿失禁或直肠损伤等并发症。结论:经尿道精囊镜技术是可行的诊断和治疗顽固性或复发性血精的新方法。

Objective ： To investigate the feasibility and effect of transurethral seminal vesiculoscopy in the diagnosis and treatment of refractory or recurrent hemospermia. Methods ： We retrospectively analyzed 162 cases of refractory or recurrent hemospermia examined and treated by transurethral seminal vesiculoscopy. The patients ranged in age from 19 to 76 years and had a hemospermia history of 3 months to 11 years, admitted due to poor therapeutic results or recurrence after 4 weeks of antibiotic medication. All the patients underwent serum PSA examination, transrectal uhrasonography, seminal vesicle uhrasonography and pelvis CT or MRI before surgery. Results ： Wine- or magenta-colored colloid and inflammation were found in one or both sides of the seminal vesicle in all the cases. Pathological biopsy revealed chronic inflammatory mucosa of the seminal vesicle in all the patients, and even calculi in the ejaculatory duct or seminal vesicle in 15 eases. Postoperative follow-up averaged 21.7 （ 12 - 29 ） months. Hemospermia disappeared or was alleviated in 150 （92.64%） of the cases after 1 - 15 ejaculations, in which 7 experienced recurrence 3 months later. Four cases taih;d to respond, and I developed acule hibateral epididymitis after surgery. No such complications as retrograde ejaculation, urinary inconlinence or rectal injury were observed postoperatiwqy. Conclusion： Transurelhra] seminal vesiculoseopy is a sate, effective and feasible new method for the treatmenl of refiraclory or recrudescent hemospermia.