精囊镜技术的改进与临床应用

Technical refinement of seminal vesiculoscopy and clinical application in seminal vesicle disease

目的 改进精囊镜技术,提高精囊镜在精囊病变诊治中的临床应用效果. 方法 2010年9月到2013年8月,以头端弯曲的专利导管引导精囊镜经精阜隐窝进入前列腺小囊,于其底部5、7点处的侧壁上,以另一种专利导管穿刺、引导精囊镜进入到精囊腔内.对58例患者,包括42例顽固性血精和16例无精子症者,进行相应处理. 结果 本组应用改进方法自前列腺隐窝进到精囊腔的时间仅需2 ～3 min,顺利进镜到精囊腔内46例,占79％.16例临床无精子症者中12例（75％）未见明显隐窝,怀疑精道梗阻,改用电切镜切除精阜隆起,直接进入前列腺小囊和精囊腔内.术后随访6～36个月（平均18个月）,42例血精患者症状消失25例（60％）,改善11例（26％）,16例无精子症者中6例治愈,5例好转,5例无变化.19例术后行顺行下尿路造影均未见造影剂反流.结论 以专利导管引导精囊镜,可经精阜隐窝和前列腺小囊快速进入精囊腔,操作技术简单易行,并对不同精囊病变进行处理,成功率高,无并发症,是一种实用的临床技术.

Objective To refine the technique and improve the efficacy of seminal vesiculoscopy in the diagnosis and treatment of seminal vesicle disease.Methods The refined techniques of seminal vesculoscopy,using a patent catheter into the slit-like ejaculatory duct orifice through the verumontanum and another patent catheter introduced into seminal vesicle lumen,were performed in 58 cases,including intractable hematospermia in 42 cases and azoospermia in 16 cases.Results Seminal vesiculoscopy was successfully entered into the seminal vesicular lumen in 46 patients （79%） within 2-3 min.There was no obvious ejaculatory duct orifice in 12 of 16 azoopermia cases,and transurethral resection of verumontanum was performed,then seminal vesiculoscope was directly entered into seminal vesicle lumen.Symptoms of hematospermia were disappeared in 25 cases （60%）,improved in 11 cases （26%）,and azoospermia were cured in 6 cases （37%）,improved in 5 （31%）,unchanged in 5 （31%） during the follow-up period of 6-36 months （average 18 months）.There were no major or minor complications in this series,and no urine reflux into ejaculatory duct in 19 cases demonstrated by contrast medium.Conclusion Refined seminal vesiculoscopy was technically safe,efficient,simple,and potentially widely used in the cases of hematospermia and ejaculatory duct obstructions.