经前列腺小囊黏膜下隧道法精囊镜检查的可行性和疗效

The feasibility and effect of transutricular seminal vesiculoscopy via submucosal tunnel

目的 分析经前列腺小囊黏膜下隧道法精囊镜检查和治疗的可行性和有效性.方法 回顾性分析2011年10月至2016年3月行黏膜下隧道法精囊镜检查术23例患者的临床资料.年龄22～46岁,平均（30.0±6.3）岁.病程1～120个月,平均（35.5±34.7）个月.术前诊断为血精4例,梗阻性无精子症14例,梗阻性无精子症＋血精2例,精囊结石1例,前列腺囊肿1例,盆腔肿物1例.术中使用F8.0/9.8输尿管镜进入前列腺小囊,于5点和7点方向在斑马导丝引导下进入黏膜下层,向顺时针、逆时针和深部延展,逐渐打开射精管侧壁,进入射精管和精囊,进行检查和治疗.结果 本组23例中,19例成功进镜并完成手术,成功率82％;余4例因炎症粘连较重,未能成功进镜手术.所有患者术中均未发生水中毒、出血、直肠损伤等并发症.19例成功接受手术者中,16例获得随访,随访时间1～55个月,平均（35.7±15.0）个月.总体症状缓解率为87.5％（14/16）,均未出现尿失禁、逆行射精等并发症.1例出现附睾炎,经抗生素治疗1周后治愈.结论 经前列腺小囊黏膜下隧道法精囊镜检查治疗是一种可行的精囊镜操作方式.

Objective To investigate the feasibility and effect of transutricular seminal vesiculoscopy via submucosal tunnel.Methods We retrospectively analyzed clinical data of 23 cases who received transutricular seminal vesiculoscopy via submucosal tunnel from October 2011 to March 2016.Patients＇age was 22-46（30.0 ±6.3） years old,history was 1-120（35.5 ±34.7） months long.Preoperative diagnosis included hemospermia （4 cases）,obstructive azoospermia （14 cases）,hemospermia and obstructive azoospermia （2 cases）,seminal vesicle stone （1 case）,prostate cyst （1 case）,and pelvic neoplasm（1 case）.We used 8/9.8F ureteroscope as seminal vesiculoscope.After entering the prostatic utricle,the seminal vesiculoscope got into the submucosa tunnel via guidance of zebra wire at the points of 5 and 7 o＇clock.Then clockwise,counterclockwise and deep extension were made,side wall of ejaculatory duct was uncovered gradually.The seminal vesiculoscope finally got into the ejaculatory duct and seminal vesicle.After then,we could conduct examination and treatment through vesiculoscopy.Results 19 of 23 （82%） patients received seminal vesiculoscopy successfully,the other 4 patients failed on account of critical adhension.Time of fellow-up was 1-55 （35.7 ± 15.0） months,14 of 16（87.5%） patients who received successful surgery got relief of various degree.No incontinence,retrograde ejaculation occurred during follow-up.One patient suffered epididymitis,but got relief after antibiotic therapy.Conclusion Transutricular seminal vesiculoscopy via submucosal tunnel was a feasible choice to conduct seminal vesiculoscopy.