输精管内滤过装置术后血精5例临床分析

Clinical analysis of 5 cases hemospermia after intra-vas device operation

目的探讨输精管内滤过装置(IVD)术后出现血精的原因及处理对策。方法对5例行IVD置入术后出现血精的患者进行检查和治疗:(1)阴囊检查3例。1例有附睾淤积症状者行单侧输精管IVD取出并输精管复通术,1例痛性结节症状者行双侧输精管结节切除并输精管复通术,1例行单侧输精管复通术。(2)行精囊镜检查1例。(3)给予抗炎止血等保守治疗1例。所有病例确定时间进行随访。结果3例复通术中2例在术后1个月至1年精液检查发现精子,1例复通后1个月精液复查发现少量精子,但其后多次复查精子消失,考虑吻合口堵塞。1例精囊镜检查术中双侧精囊内均未找到IVD。所有病例随访半年以上血精仍没有消失。结论 IVD术后长期的血精应该引起必要的重视,血精症状的反复发作及迁延不愈往往给患者造成巨大的心理压力。输精管节育术后应加强定期随访,及时发现身体异常情况,及时处理,减少IVD严重并发症发生,建议对于放置IVD的年限以及在取出IVD前定期随访都应有严格明确的规定。

Objoetive To investigate the cause and treatment of hemospermia after intravasal device operation. Methods Among 3 cases of scrotal exploration, 1 case of epididymal stasis symptoms received unilateral vas IVD removed and vas deferens reanastomosis, 1 case with painful nodules symptoms received bilateral vas nodule resection and vas deferens reanastomosis, 1 patient underwent unilateral vas deferens reanastomosis; Other two cases respectively received seminal vesicle endoscopy examination and conservative therapy. All cases were followed up to determine the time. Results Among 3 cases of recanalization, 2 cases of them had sperm in semen examination after operation 1 month -1 year, 1 case had a few sperm in semen after 1 month, but then no sperm in the repeated review, indicating that the anastomosis was blocked; In 1 case of seminal vesicle bronchoscopy. IVD was not found within bilateral seminal vesicle; Hematospermia still occurred for all patients during followed up for more than half a year. Conclusion The long term hemospermia should be paid more attention after intra-vas device operation, and these symptoms of recurrent and delayed healing often cause great psychological pressure to the patients. We should follow-up regularly after intra-vas device operation, observe physical abnormalities, treat these timely, and reduce serious complications. It is recommended to set deadline of IVD placement, regular follow-up, until to IVD removing.