经尿道精囊镜治疗28例男科疾病临床观察

Transurethral Seminal Vesiculoscopy in the Rreatment of Male Disease( a report of 28 cases)

目的探讨经尿道精囊镜技术在男科疾病诊治中的应用价值。方法入选28例男科疾病患者，其中顽固性血精18例、不育症5例、会阴部疼痛2例、射精后下腹部疼痛1例、射精无力伴精液量少1例、性交后血尿1例。年龄18—63岁，平均（38±13）岁。采用麻醉下经尿道置入F7／8．5、F8／9．8输尿管硬镜，检查精囊及输精管壶腹部，并直视下行冲洗、钬激光碎石取石及广谱抗菌素保留灌注。术后定期随访患者主观症状、精液性状或配偶妊娠情况。结果本组病例手术时间30～140min，平均（59±29）min。随访1—50个月，平均（8±10）个月。治愈12例，好转7例，未愈9例，治愈好转率67．9％。所有病例术后均未出现附睾炎、逆行射精、尿失禁和直肠损伤，偶有射精管梗阻复发或性交时精液自溢等并发症。结论精囊炎症或结石、射精管囊肿或梗阻是导致顽固性血精、射精疼痛、性交后血尿、不育症等男科疾病难治的重要原因，利用腔镜技术行精囊内检查及治疗具有诊断明确、创伤小、效果好、并发症少等优点，是治疗顽固性血精、射精疼痛、性交后血尿、不育症的有效方法。

Objective To evaluate the application value of Transurethral seminal vesiculoscopy in the diagnosis and treatment of male diseases. Methods A retrospective analysis was made on the clinical data of 28 cases, which included persistent hemato- spermia in 18 cases, acyesisin 5, Perineum pain in 2 hypogastrium pain after ejaculation in 1, semination incapable in 1 and hematuria after sexual intercourse in 1 in our department. The age ranged from 16 to 63 years ＇（ mean ,38 ± 13 ）. In the case of anesthesia, insert a F7/8.5, F8/9.8 Ureteroscope into urethra, check the seminal vesicle and ampulla of vas defererntis, then wash off the old blood .9 fragment and remove stone with Ho：YAG,or reserve perfusion with broad spectrum antibiotic Ureteroscopically. The patients＇ subjective symptomsemen analysis and their spouse＇ s cyesis were followed up postoperatively. Results The operating time was （30 - 140 ） min with a mean of （ 59 ± 29 ） min. The follow-up period was （ 1 - 50 ） months with a mean of （ 8 ± 10 ） months. Cure in 12 cases,improved in 7 cases,9 cases recovered, heal the recovery rate of 67.9%. All cases did not appear epi- didymitis,retrograde ejaculation,urinary incontinence and rectal damage, with occasional complications, such as ejaculatory duct obstruction recurrence or automatic semen overflow when sexual intercourse. Conclusion Seminal vesicle inflammation or stones, ejaculatory duct cyst or obstruction were important reasons that cause the difficulty of the diagnosis and treatment of male diseases,including persistent hematospermia,painful ejaculation, hematuria after sexual intercourse, acyesis and so on. Transurethral seminal vesiculoscopy was minimally invasive, safety and efficient with few complications. It was an effective therapeutic approach to persistent hematospermia, painful ejaculation, hematuria after Sexual intercourse and acyesis.