软性输尿管镜精囊检查在顽固性血精诊治中的应用价值

The value of flexible ureteroscope seminal vesicle examination for diagnosing and treating refractory hemospermia

目的探讨使用软性输尿管镜行精囊检查诊治顽固性血精的可行性和安全性,分析其临床应用价值。方法顽固性血精患者26例,年龄18~63岁,病程9个月至5年,术前行尿常规、前列腺液常规及细菌培养、直肠指诊、经直肠前列腺及精囊彩超、盆腔CT或MRI检查。采用蛛网膜下腔麻醉,使用Olympus 3.6/9.9 F软性输尿管镜经尿道行精囊检查。结果本组患者均成功实施了精囊镜检查,手术时间20~76 min,平均（25±11）min。术后留置尿管1~2 d,住院时间3~8 d,平均（4±1）d。患者随访均超过3个月,随访期间内24例患者血精完全消失。除少数患者出现轻微血尿或膀胱痉挛外,无严重并发症发生。结论经尿道软性输尿管镜精囊检查操作更简单,创伤更微小,可作为顽固性血精的有效方法。

Objective To investigate the feasibility and safety of flexible ureteroscope in seminal vesicle examination for diagnosing and treating refractory hemospermia.Methods 26 refractory hemospermia patients were identified,18-63 years old,with 9 months to 5 years duration.Before operation,all the patients received routine urine examination,prostatic secretious examination and bacterial culture,digital examination,transrectal ultrasound of prostate and seminal vesicle,pelvic CT or MRI.Olympus 3.6/9.9 F flexible ureteroscope was performed under subarachnoid anesthesia in operation.Results All the operation were performed successfully.The mean operation time was（25±11） minutes（range：20-76 minutes）,mean hospital stay was（4±1） days（range：3-8 days）,with indwelling urinary catheter for 1-2 days after operation.All the patients were followed up over 3 months.Hemospermia was completely cured in all the cases.No severe complications except for some slight hematuria and bladder spasm occurred.Conclusion The application of flexible ureteroscope in seminal vesicle examination has advantages of simple operation and minimal invasion.It is an effective method to treat refractory hemospermia.