经尿道内镜治疗巨大精囊囊肿的临床分析(附7例报告)  

Transurethral endoscopic treatment of giant seminal vesicle cyst: report of 7 cases

作　　者：李波军 王明松[2] 黄灶明[2] 罗勇[2] 张勇[2] 李珂[2] 张克勤[2] 靳风烁[2] 李彦锋[2] 

机构地区：[1]绍兴市上虞人民医院泌尿外科,浙江绍兴312300 [2]第三军医大学大坪医院野战外科研究所泌尿外科,重庆400042

出　　处：《第三军医大学学报》2015年第15期1585-1589,共5页Journal of Third Military Medical University

基　　金：大坪医院全军计划生育优生优育中心课题资助项目(505-1539)~~

摘　　要：目的总结7例巨大精囊囊肿的诊治经验，结合文献对该病的发病机制、临床和影像学特征、诊断及治疗进行分析讨论。方法回顾性分析第三军医大学大坪医院野战外科研究所泌尿外科2009年1月至2014年5月收治的7例巨大精囊囊肿患者的临床资料、影像学检查结果及手术治疗情况，随访术后恢复情况，分析治疗效果及有无术后并发症。结果精囊囊肿在CT或MRI下显示为定位于膀胱后方、前列腺上方、偏离中线的盆腔囊性占位，大小约8．26cm×7．98cm×4．85am至9．27cm×8．95em×8．15cm。其中2例单侧精囊巨大囊肿伴发先天性同侧肾、输尿管缺如，考虑为先天性畸形；另外5例表现为单纯精囊巨大囊肿，考虑为后天性射精管道梗阻所致。7例患者均成功实施经尿道内镜下精囊囊肿去顶减压加囊壁电灼术，术后病理结果均证实为精囊囊肿，未见肿瘤。术后随访显示术前各类不适症状消失，无勃起及性功能障碍，射精及性高潮同术前。无膀胱、直肠损伤等严重并发症发生。术后3～6个月复查囊肿显著缩小或消失。结论MRI检查能根据盆腔囊肿的定位清楚分辨其来源，并根据囊肿内信号特征改变判断其性质。采用经尿道内镜下囊肿去顶减压加囊壁电灼术较以往开放和腹腔镜手术更加微创和安全。Objective To summarize the radiological manifestations and our experiences on transurethral endoscopic treatment of giant seminal vesicle cyst, and analyze the pathogenesis, clinical and imaging characteristics, and corresponding diagnosis and treatment. Methods The clinical data of 7 cases of giant seminal vesicle cyst, including clinical symptoms, radiological images, transurethral endoscopic treatment procedure and postoperative follow-up, were retrospectively reviewed and analyzed. Results The images of other 5 cases showing simple giant seminal vesicle cyst were supposed to be caused by acquired ejaculatory duct obstruction. All the 7 cases of giant seminal vesicle cyst were successfully treated by transurethral endoscopic procedure including unroofing decompression and mucosa electrocautery. All the seminal vesicle cysts were confirmed by the pathological results, and no tumor was found. Postoperative follow-up showed that all the preoperative symptoms disappeared. Neither complication such as erection, ejaculation or orgasm dysfunction nor bladder or rectum injury was found. The seminal vesicle cysts were significantly decreased or disappeared in the postoperative 3 -6 months. Conclusion MRI examination can clearly distinguish the cyst sources according to the cyst location and signal change, and offer an important guidance for the diagnosis and treatment of the pelvic cysts. Compared with the traditional open surgery and laparoscopic surgery, the transurethral unroofing decompression plus mucosa electrocautery is more minimally invasive, safe and reliable, and can be the first choice for the treatment of giant seminal vesicle cyst.

关 键 词：精囊 囊肿 微创 手术治疗 

分 类 号：R697.41[医药卫生—泌尿科学] R699.8[医药卫生—外科学]