射精管囊肿2例诊治报告并文献复习

Diagnosis and treatment of ejaculatory duct cyst: A report of 2 cases and review of the literature

目的:探讨射精管囊肿的诊断与治疗方法,观察应用微创治疗本病的远期效果。方法:2014年7月-2014年8月收治2例患者分别以血精、会阴部不适就诊患者,经B超、CT和MRI检查未能明确诊断,行经阴囊皮肤穿刺输精管造影和经尿道囊肿电切,囊壁送病理及免疫组化检查,结合文献讨论其临床表现,影像、病理特征、鉴别诊断及治疗方法。结果:切下组织显微镜下见囊壁主要由平滑肌组成,囊内壁由假复层纤毛柱状上皮衬覆,进一步行免疫组化示CD10(+),Muc6(+),结合这些检查结果,此2例患者确诊为中肾管源性射精管囊肿。随访18~20个月,术后患者不适症状消失,患者1复查精液常规:量3.5 ml,精子浓度35×10~6/ml,精子活动度a级精子百分率32.0%,b级精子百分率18.0%,液化时间30 min。患者2精液常规:量3.1 ml,精子浓度32×10~6/ml,精子活动度a级精子百分率26.0%,b级精子百分率31.0%,液化时间34 min。射精管囊肿未复发。结论:B超、CT、MRI检查虽可发现盆腔囊性包块,但确诊需结合输精管造影,病理学和免疫组化检查,经尿道射精管囊肿开窗手术创伤小且安全有效。

Objective： To investigate the diagnosis and treatment of ejaeulatory duct cyst. Methods： This study included 2 male patients present at the hospital for hemospermia and abnormal sensation in the perineal region in July and August 2014. Both un- derwent transrectal ultrasonography, routine semen examination, CT, MRI, cystoscopy, and vesiculography before transurethral fenes- tration of the cysts and pathological examination of the cyst wall specimens. Analyses were made on the clinical presentations, imaging features, pathological characteristics, differential diagnosis and treatment of ejaculatory duct cyst and relevant literature was reviewed. Results： The cyst wall was mainly composed of smooth muscle, the inner wall lined with pseudostratified ciliated columnar epithelia, and with positive expressions of CD10 and Muc6 proteins on immunohistochemical staining, which indicated renal iatrogenic ejaculatory duct cyst. The patients were followed up for 18 and 20 months, respectively. All symptoms disappeared and no recurrence occurred ＂after surgery. Routine semen examination for the two patients showed the semen volumes to be 3.5 and 3.1 ii11, sperm concentrations 35 and 32 x 106/ml, grade a sperm 32.0 and 26.0% , grade b sperm 18.0 and 31.0% , and semen liquidation time 30 and 34 minutes, respectively. Conclusion： Pelvic cystic masses can be detected by transrectal ultrasonography, CT and MRI, but definite diagnosisrelies on vesivulography, pathological examination and immuuohislovhemical slaining.