精囊镜下铥激光治疗射精管梗阻的临床结局分析

Seminal vesiculoscopy-assisted thulium laser ablation for the treatment of ejaculatory duct obstruction:An analysis of clinical outcomes

目的:评估射精管梗阻所致的少精子症或无精子症患者行精囊镜下铥激光烧灼术治疗后的临床结局。方法:回顾性分析2018年4月至2020年1月42例南京医科大学第一附属医院泌尿外科男科门诊因射精管梗阻导致的少弱精子症或无精子症患者的临床资料,术前均经相关检查诊断明确,术中利用精囊镜寻找射精管开口,铥激光技术解除射精管梗阻,术后定期随访,监测患者精液常规变化,对手术前后参数采用t检验。结果:42例患者术前完善相关检查,均行经尿道精囊镜探查,并辅以铥激光治疗射精管梗阻,平均手术时间为52.7 min,与患者术前两周精液常规相比,患者术后3个月,6个月及9个月精液体积,精子浓度,精子总活力显著改善(P<0.05),所有患者精液常规中均发现精子,其中40例患者于术后3个月内于精液常规中发现精子,2例患者于术后6~9月于精液常规中发现精子,其中7例患者出现术后并发症,包括附睾炎,会阴部或睾丸疼痛及术后血尿,经相应对症治疗后症状消失,所有病例术后均未出现逆行射精,直肠损伤,尿道狭窄或尿失禁等严重并发症。结论:作为治疗射精管梗阻的强有力武器,精囊镜探查辅以铥激光技术可行,术后并发症较少,患者术后精子质量恢复较好,是治疗射精管梗阻性少弱精子症安全且有效的手段。

Objective:To evaluate the clinical outcomes of seminal vesiculoscopy-assisted thulium laser ablation(SVS-TLA)in the treatment of oligoasthenozoospermia or azoospermia induced by ejaculatory duct obstruction(EDO).Methods:We retrospectively analyzed the clinical data on 42 cases of EDO-induced oligoasthenozoospermia or azoospermia in our Clinic of Andrology from April 2018 to January 2020,all definitely diagnosed and treated by SVS-TLA.We followed up the patients regularly after operation,obtained their routine semen parameters at 3,6 and 9 months postoperatively,examined them by t-test and compared them with the baseline.Results:Operations were successfully completed in all the 42 cases,with an average surgery time of 52.7 minutes.Compared with the routine semen parameters collected 2 weeks before surgery,the semen volume,sperm concentration and total sperm motility of the patients were all significantly improved at 3,6 and 9 months postoperatively(P<0.01).Sperm were found in 40 cases at 3 months and in the other 2 cases at 6 and 9 months after surgery.Postoperative complications were observed in 7 cases,including epididymitis,perineal or testicular pain,and hematuria,which all disappeared after corresponding symptomatic treatment.No such serious complications as retrograde ejaculation,rectal injury,urethral stricture or urinary incontinence occurred in any of the cases after operation.Conclusion:SVS-TLA is a safe and effective option for the treatment of EDO,which can significantly improve the semen quality of the patient without causing serious postoperative complications.