顽固性血精伴精囊结石的内镜治疗及病因分析

Seminal vesiculoscopic therapy and aetiological analysis of refractory hematospermia with seminal vesicle calculi

目的探讨精囊内镜技术诊断与治疗顽固性血精伴精囊结石的实用性及有效性,并分析精囊结石形成的原因。方法回顾性分析我院2016年2月至2019年11月诊治的11例血精伴精囊结石患者的临床资料,分析精囊结石成分,探究其病因,并对患者进行随访观察,评价疗效。结果新鲜出血者精囊MRI在T1WI相上呈高信号,在T2WI相上呈低信号;而陈旧性出血者表现为T1WI、T2WI相上呈中到高强度信号影。所有患者均有精囊出血,均可见精囊结石,精囊液浑浊,囊壁充血水肿,其中8例患者射精管开口狭窄或闭塞。所有患者均成功接受精囊内镜手术,术后均未出现并发症。完整取出结石3例,行成分分析,其中2例为碳酸磷灰石结石,1例为二水草酸钙结石。术后1例患者失访,10例患者随访成功,其中9例患者血精症状于1~3个月内消失且无复发,有效率为90%;1例患者症状改善不明显,于术后2年复发血精。结论血精伴精囊结石的形成可能与感染、精道梗阻、尿液反流、代谢等因素有关,精囊内镜技术诊治血精伴精囊结石安全、有效。

Objective To investigate the practicability and efficacy of seminal vesiculoscopy in the diagnosis and treatment of refractory hematospermia with seminal vesicle calculi,and analyze the causes of seminal vesicle calculi. Methods Clinical data of 11 patients with refractory hematospermia with seminal vesicle calculi in our hospital from February 2016 to November 2019 were retrospectively analyzed. The compositions of seminal vesicle calculi were analysed in order to explore the aetiology. And the long-term treatment efficacy was followed up as well. Results Fresh hemorrhages in the seminal vesicles showed high signal intensity on T1-weighted images and low signal intensity on T2-weighted images by MRI,while old hemorrhages in the seminal vesicles revealed middle to high signal intensity on both T1-weighted and T2-weighted images. Seminal vesicle hemorrhage,seminal vesicle calculi,turbid seminal vesicle fluid,congestion and edema of the cyst wall were found in all patients,and stenosis or occlusion of the ejaculatory duct in 8 patients. The seminal vesiculoscopy was performed in all patients successfully. Postoperative complications were not observed.. The calculi( 3 cases) were completely taken out and the components were analyzed,including 2 cases of carbonate apatite and 1 case of calcium dihydrate oxalate. In all patients,10 patients were followed up successfully and 1 patient was lost. The hematospermia of 9 patients disappeared within 1 to 3 months without recurrence,and the effective rate was 90%. The hematospermia of 1 patient was not significantly improved,and recurred 2 years after the operation. Conclusion The formation of hematospermia with seminal vesicle calculi may be related to infection,ejaculatory duct obstruction,urine reflux,metabolism and et al. The seminal vesiculoscopy is safe and effective in the diagnosis and treatment of hematospermia with seminal vesicle calculi.