精囊镜治疗21例顽固性血精的疗效分析

Report of seminal vesiculoscopy performed on twenty-one patients with intractable hematospermia

目的探讨应用精囊镜治疗顽固性血精的临床疗效。方法自2011年10月至2013年2月,广东医学院第二附属医院对21例顽固性血精患者行精囊镜检查,入院前血精时间超过半年,经过中西医药物治疗和物理治疗,症状反复出现,入院后行超声及CT排除前列腺肿瘤,使用Wolf 7.5 F输尿管硬镜行精囊镜检查,术后静脉使用抗生素治疗及留置尿管。结果 21例手术均成功,其中4例需使用电切镜切开精阜暴露射精管,手术时间20-43 min,平均25 min,1例术后出现发热,无附睾炎、尿道损伤、直肠损伤、逆行性射精等严重并发症,16例在精囊镜检查后3个月内血精完全消失,3例术后使用中药及抗生素治疗后血精消失,2例仍反复血精。结论采用精囊镜对一些久治不愈的血精患者进行检查和治疗,既可以明确诊断,又可以对精囊进行冲洗,结合药物治疗,具有创伤小、效果好、并发症少等优点,是治疗顽固性血精的有效方法之一。

Objective To explore clinical application of seminal vesiculoscopy on patients with intractable hematospermia that do not respond to conservative treatments. Methods From October 2011 to February 2013, twenty- one patients with intractable hematospermia underwent seminal vesiculoscopy in the Second Affriliated Hospital of Guangdong Medical College. Before admission to hospital, all these patients have suffered hematospermia over half a year and received both western medicine and traditional medications as well as physical treatments. However the patients′ symptoms of hematospermia still reoccurred over and again. After admission to hospital, B-mode ultrasound and CT scans were conducted on the patients to rule out the possibility of prostate tumor. Examination of seminal vesiculoscopy with Wolf 7.5 F rigid ureteroscope was further performed. After surgical operations, the patients received intravenous infusion of antibiotics and wore indwelling catheters. Results All surgical operations were successfully performed on the above twenty-one patients. Among the patients, 4 patients needed to have their seminal colliculuses cut open through resectoscope to have their ejaculatory ducts exposed. The surgical operations lasted for 20 to 43 minutes（25 minutes average）. After undergoing surgical operations, one of the patients experienced fever but did not develop any complications such as epididymitis, urethral trauma, anorectal injury, or retrograde ejaculation etc; sixteen patients′ hematospermia is completely cured within three months after receiving treatments with seminal vesiculoscopy; three patients′ hematospermia disappeared after undergoing surgical operations and having auxiliary treatments of traditional Chinese medicines and antibiotics; two patients still have reoccurring hematospermia. Conclusions Seminal vesiculoscopy is an effective approach on diagnosis and therapies in patients suffering hematospermia for long periods. It can be used to confirm the diagnosis, and as well be used to wash the seminal vesicle. In view of its advantages including causing minimal trauma, having good surgical operations results and low risk of complications, seminal vesiculoscopy, when being employed together with proper medications, is considered to be one of the most effective measures in treating intractable hematospermia,.