术中超声辅助对精囊镜检成功率及精囊腺疾病治疗的效果观察

Efficacy of real-time transrectal ultrasonography in seminal vesiculoscopy and treatment of seminal vesicular diseases

目的探讨对经自然腔道无法进入精囊腺患者施术中行超声辅助引导精囊镜手术的有效性。方法收集唐都医院泌尿外科2015年9月至2017年1月经自然腔道无法顺利进入精囊腺的患者26例,实施术中超声辅助引导下精囊镜手术,观察术中进镜成功率及并发症、治疗效果等。结果采用术中超声引导下成功进入精囊23例。手术总成功率为88.5%(23/26)。手术时间平均(66.5±20.8)min。术后随访时间平均(3±2.6)个月(失访2例)。患者病情改善率为:血精100%(4/4)、梗阻性无精症37.5%(3/8,2例术后失访)、弱精症78.6%(11/14)。术后随访24例患者中出现下尿路刺激症1例,无逆行射精、尿失禁及直肠损伤等并发症。结论对于经自然腔道无法进入精囊腺的患者,术中超声引导下经前列腺小囊进镜能显著提高手术成功率,减少术中对前列腺和直肠的损伤,有效并可行。

Objective To investigate the efficacy of real-time transrectal ultrasonography in seminal vesiculoscopy when the seminal vesicle was unable to be reached through the natural cavity.Methods A total of 26 patients with seminal vesicle diseases who underwent seminal vesiculoscopy during Sep.2016 and Jan.2017 were retrospectively analyzed.During seminal vesiculoscopy,as the seminal vesicle could not be reached through natural cavity,transrectal ultrasonography was performed.The success rate,complications and therapeutic effects were observed.Results Operations were successfully performed in 23(88.5%) of the 26 cases.The average operation time was(66.5±20.8) min.During the average follow-up of(3±2.6) months(with 2 cases lost to follow-up),the cure rates of hematospermia,obstructive azoospermia and asthenozoospermia were 100%(4/4),37.5%(3/8) and 78.6%(11/14),respectively.Low urinary tract stimulation occurred in 1 patient.No complications such as retrograde ejaculation,urinary incontinence or rectal urethral fistula were observed.Conclusion For patients whose seminal vesicle cannot be reached through natural cavity,ultrasound-assisted seminal vesiculoscopy may achieve a high success rate and avoid injury on prostate and rectum.