精囊镜诊治顽固性血精的临床价值

Experiences exploration of seminal vesicle endoscopy technology in diagnosis and treatment of refractory hemospermia

目的探讨精囊镜技术在血精诊治中的临床价值。方法 19例临床诊断为顽固性血精的患者,术前前列腺液培养加药敏,经直肠B超(TRUS),精囊MRI或CT扫描等检查排除精囊肿瘤、结核、前列腺癌;经尿道F4.5/6输尿管镜进行精囊镜检,冲洗精囊内陈旧性血块,合并精囊结石用钬激光碎石,术中喹诺酮类药物精囊保留灌注。术后应用非那雄胺4周。结果 19例患者中,18例(94.74%)成功获双侧精囊镜检、冲洗、药物保留灌注,1例成功获患侧精囊镜检、治疗,随访6月～1年,18例患者血精消失,1例复发经敏感抗生素抗炎治疗后好转。结论经尿道F4.5/6输尿管镜进行精囊镜检是一种治疗顽固性血精安全而有效的方法。

Objective To investigate the clinical value of seminal vesicle endoscopy technique in the diagnosis and treatment of hemospermia.Methods Nineteen patients clinically diagnosed with refractory hemospermia were included in the study.Prostatic fluid culture and drug sensitivity test were performed before the surgery.TRUS,seminal MRI or CT scan for seminal vesicles were carried out to exclude tumor of seminal vesicle,tubercle and carcinoma of prostate.Seminal vesicle endoscopy was conducted using urethra F4.5/6 ureteroscope,old coagulated blood in seminal vesicles was washed.Holmium laser was used to break calculus of seminal vesicle and quinolones was perfused into the seminal vesicles during the surgery.Four weeks finasteride therapy followed after operation.Results For 19 patients,18 patients successfully received bilateral seminal vesicles endoscopy,washing and drug reserved perfusion.One patient completed injured seminal vesicle endoscopy and treatment.Six months to one year follow-up indicated that no hemospermia was found in 18 patients and one patient was diagnosed with hemospermia recurrence.The symptoms were improved after sensitive antibiotics anti-inflammatory treatment.Conclusion Seminal vesicle endoscopy per urethra using F4.5/6 ureteroscopes is a safe and effective method to treat refractory hemospermia.