精囊镜技术治疗血精的临床应用进展

Progress in the clinical application of seminal vesicle technique in the treatment of hemospermia

血精是指射精或遗精时排出血性精液,是一种常见的男科临床疾病。精囊镜技术在泌尿男科疾病中被用于诊治顽固性血精症及伴有精道结石的患者,具有疗效好、并发症少等优势,同时随着微创技术的进步,寻找射精管开口的技术方法逐渐改进,自早年国内专家提出的从射精管的自然通道开口,以及前列腺小囊内进镜到最近提出的“掀帘法”进镜,新的方法对于无法找寻到射精管通道自然开口的患者,具有更快捷、准确、微创地进入射精管道的优势,解决了患者的血精症状且疗效较好,但上述方法缺乏多中心的病例研究,仍存在逆行感染、精道损伤、射精管再度梗阻狭窄等并发症,故需严格掌握适应证。精囊镜技术作为一项新兴的微创技术还不够成熟,本文回顾近年来国内外专家应用精囊镜治疗血精的研究,将对近年来精囊镜技术诊治顽固性血精症的手术适应证、手术方法和技巧、常见并发症的处理以及其应用前景展望等作一综述。

As a common andrological disease,hemospermia refers to the discharge of bloody semen during ejaculation or nocturnal emission.Seminal vesiculoscopy is used in the diagnosis and treatment of intractable hemospermia and seminal tract stones in urology and male diseases,with good curative effect and few complications.With the advancement of minimally invasive technology,it is necessary to find the ejaculatory duct opening.Technical methods have been gradually improved.Domestic experts have proposed the opening of the natural passage of the ejaculatory duct,endoscopy of the prostatic capsule,as well as the“lifting curtain method”.The new methods have advantages of faster,more accurate and more minimally invasive access to the ejaculatory duct for patients who cannot find the natural opening of the ejaculatory duct,so as to relieve the symptoms of hemospermia and achieve a good effect.However,due to the lack of multi-center case studies,there are still complications such as retrograde infection,injury of the seminal canal,and re-obstruction and stenosis of the ejaculatory duct.Therefore,indications should be strictly controlled.As an emerging minimally invasive technology,seminal vesiculoscopy will take some time to mature.This article reviews recent studies on the application of seminal vesiculoscopy in the treatment of hemospermia by domestic and foreign experts,and reviews the surgical indications,surgical methods and techniques,management of common complications,and prospects of application.