精道内镜技术治疗顽固性血精的疗效和安全性  

Seminal vesiculoscopy:Safe and effective for the treatment of refractory hemospermia

作　　者：刘家钦[1] 陈锐[1] 沈明[1] 于建红[1] 董彪[1] 江专新[1] LIU Jia-qin;CHEN Rui;SHEN Ming;YU Jian-hong;DONG Biao;JIANG Zhuan-xin(Department of Andrology,The Second Affiliated Hospital of Kunming Medical University,Kunming,Yunan 650101,China)

机构地区：[1]昆明医科大学第二附属医院男性科,云南昆明650101

出　　处：《中华男科学杂志》2022年第11期1011-1014,共4页National Journal of Andrology

摘　　要：目的:探讨应用精道内镜技术经前列腺小囊途径治疗顽固性血精的疗效和安全性。方法:通过6F输尿管镜经前列腺小囊途径治疗顽固性血精及精道远端梗阻性疾病患者103例,其中精道远端囊肿合并顽固性血精12例,术中冲洗精囊腔并清除结石,钬激光将囊肿壁切除,术后随访12个月。结果:103例手术均顺利进行,1例(0.9%)顽固性血精患者未成功进入双侧精囊腔,其余手术均顺利完成,手术时间为(47±9) min,术中无直肠损伤、急性附睾炎等手术并发症发生,术后无发热、长期尿痛、长期血尿等不适,术后2例(1.9%)精液带血症状无明显缓解,4例(3.9%)精液带血症状明显好转,3例(2.9%)顽固性血精症患者精液带血症状复发,均再次行手术后症状好转,其余93例(90.3%)精液带血症状治愈。结论:应用精道内镜技术治疗顽固性血精具有解剖清晰、疗效显著、创伤小等特点,同时应用钬激光切除囊肿壁相对于等离子电切具有一定优势。Objective:To investigate the clinical effect and safety of transutricular seminal vesiculoscopy in the treatment of refractory hemospermia.Methods:Using 6Fr ureteroscopy through the prostatic utricle,we treated 103 cases of refractory hemospermia with distal seminal duct obstructive lesions,including 12 cases complicated by distal seminal duct cyst.We rinsed the seminal duct cavity,cleaned out the stones,removed the cyst wall with holmium laser and followed up the patients for 12 months postoperatively.Results:The operations were successfully completed in all the cases but 1(0.9%),in which the ureteroscope failed to enter the bilateral seminal vesicles.The operation time was(47±9)min.No rectal injury or acute epididymitis occurred intraoperatively,nor fever,long-term dysuria or long-term hematuria after surgery.Postoperative follow-up showed that bloody semen symptoms vanished in 93(90.3%)of the cases,improved significantly in 4(3.9%)and not significantly in 2(1.9%),and 3 cases of recurrence(2.9%)were all relieved after reoperation.Conclusion:Transutricular seminal vesiculoscopy has the advantages of clear anatomic vision,minor invasiveness and significant effectiveness in the treatment of refractory hemospermia.What's more,holmium laser is better than plasmakinetic resection in removal of the cyst wall.

关 键 词：精道内镜 顽固性血精 精道远端囊肿 

分 类 号：R697.4[医药卫生—泌尿科学]