TRUS引导下精囊镜手术治疗难治性精囊炎疗效分析

Effect analysis of TRUS-guided seminal vesiculoscopy for refractory seminal vesiculitis

目的 探讨经直肠实时超声(real-time transrectal ultrasound, TRUS)引导下精囊镜手术治疗抗生素治疗无效精囊炎的疗效。方法 选取2018年6月至2022年6月我院收治的难治性精囊炎患者共108例,均经抗生素治疗4周以上无效,采用简单随机分组法分为两组,各54例:对照组采用常规精囊镜手术治疗,试验组行TRUS引导下精囊镜手术。比较两组患者的围手术期指标、精囊腺参数、精液检查结果、勃起功能评分及术后并发症。结果 两组均顺利完成手术。与对照组比较,试验组手术时间和住院时间更短,手术成功率更高,而术后并发症发生率更低,差异均有统计学意义(P<0.05)。治疗后两组精囊腺左右侧纵径(longitudinal diameter, LD)、横径(transverse diameter, TD)和体积等均较治疗前缩小(P<0.05),但组间比较无统计学差异(P>0.05)。治疗后两组精液镜检WBC、 RBC计数及勃起功能IIEF-5评分均较治疗前明显改善,且试验组RBC、 WBC计数低于对照组,IIEF-5评分高于对照组,差异均有统计学意义(P<0.05)。两组患者均未出现直肠损伤、膀胱损伤、逆向射精等严重并发症。结论 对于抗生素治疗无效的难治性精囊炎,TRUS引导下精囊镜手术能够明显提高手术成功率,有效减少术后并发症,改善患者炎症反应和勃起功能。

Objective To study the effect of real-time transrectal ultrasound(TRUS)-guided seminal vesiculoscopy for the patients suffered refractory seminal vesiculitis with ineffective antibiotic treatment.Methods A total of 108 seminal vesiculitis cases with ineffective antibiotic treatment(>4 weeks)admitted to our hospital from June 2018 to June 2022 were selected and divided into two groups randomly,with 54 cases in each group:The control group was treated with conventional seminal vesiculoscopy,while the experiment group was treated with TRUS-guided seminal vesiculoscopy.Surgical indicators,postoperative complications,semen test and erectile function were compared between the two groups.Results The operations were accomplished successfully in both groups.Compared with the control group,the operation time and hospitalization time were shorter,the success rate of operation was higher,and the incidence of postoperative complications was lower in the experiment group,and all the differences were statistically significant(P<0.05).The longitudinal diameter(LD),transverse diameter(TD)and volume of left-and right lateral seminal vesicle after the surgery were less than those before the surgery in both groups(P<0.05),but there was no statistical difference in the parameters mentioned above between the two groups after the surgery(P>0.05).The counts of RBC and WBC of semen and International Index of Erectile Function Score(IIEF-5)were improved after the surgery than those before the surgery in both groups after the surgery,and the counts of RBC and WBC were lower and IIEF-5 scores were higher in the experiment group than those in the control group,and all difference were statistically(P<0.05).No serious complications such as rectal injury,bladder injury and retrograde ejaculation were found in both groups.Conclusion TRUS-guided seminal vesiculoscopy can significantly improve the success rate of surgery,promote the recovery,reduce postoperative complications incidence and improve the inflammatory response and erectile function for refractory seminal vesiculitis patients with ineffective antibiotic treatment.