8.5/11.5F精囊镜在顽固性血精诊治中的应用

8.5/11.5F transurethral seminal vesiculoscopy in the diagnosis and treatment of refractory hematospermia

目的:探讨8.5/11.5F精囊镜技术在顽固性血精诊治中的临床应用价值。方法:回顾分析2012年6月至2014年6月应用8.5/11.5F精囊镜技术诊断和治疗顽固性血精患者78例,术前行血清前列腺总特异性抗原(t PSA)、经直肠超声、盆腔MRI或CT扫描等检查,应用8.5/11.5F精囊镜观察精阜、前列腺小囊,在超滑镍钛导丝引导下将精囊镜通过射精管开口或射精管内侧管壁开窗进入精囊,进行检查、冲洗、取石、钬激光碎石等治疗。结果:78例患者均顺利完成手术。术中发现射精管开口异常5例,前列腺小囊及精囊粘膜炎性充血78例,合并精囊内暗红色胶浆样物质34例,合并精路结石19例,合并精囊小息肉2例,合并射精管或精囊囊肿4例,行冲洗、取石、钬激光碎石、息肉切除等治疗。术后轻度肉眼血尿13例,均于术后2周内消失;盆腔血肿1例,经保守治疗,术后3个月血肿消失;急性附睾炎2例,应用抗感染治疗后感染控制。术后随访1年,3例患者术后再次出现血精。结论:应用F8.5/11.5精囊镜技术对顽固性血精患者进行诊治,具有操作舒适、视野广、操作通道大、并发症少等优点,值得在临床推广。

Objective： To investigate the clinical application value of 8. 5 /11. 5 F transurethral seminal vesiculoscopy in the diagnosis and treatment of refractory hematospermia. Methods： We retrospectively analyzed 78 cases of refractory hematospermia diagnosed and treated by 8. 5 /11. 5 F transurethral seminal vesiculoscopy from June 2012 to June 2014. The patients underwent serum PSA examination,transrectal ultrasonography,seminal vesicle ultrasonography,and pelvis CT or MRI before surgery,and all received transurethral seminal vesiculoscopy under the 8. 5 /11. 5 F rigid ureteroscope. Results： Operations were all successfully accomplished,which revealed abnormal opening of the ejaculatory duct in 5 cases,mucosal inflammatory hyperemia in the prostatic utricle and seminal vesicle in 78,dark red mucilage substance in the seminal vesicle in 34,seminal vesicle stones in 19,small polyp in the seminal vesicle in 2,and ejaculatory duct or seminal vesicle cyst in 4. All the patients received symptomatic treatment during the surgery. After surgery,hematouria was found in 13 cases,which disappeared within 2 weeks,pelvic hematoma in 1 case,which was cured by conservative treatment within 3 months,and epididymitis in 2 cases,which was controlled by anti-infection treatment. Hematospermia recurred in 3 cases during the 1-year postoperative follow-up. Conclusion： 8. 5 /11. 5 F transurethral seminal vesiculoscopy,with its advantages of easy operation,wide field of vision,large channel for operation,and few complications,deserves general clinical application in the diagnosis and treatment of refractory hematospermia.