精囊镜治疗常染色体显性多囊肾病相关精囊疾病的疗效分析  

Efficacy and safety analysis of transurethral seminal vesiculoscopy in the treatment of autosomal dominant polycystic kidney disease related seminal vesicle disease

作　　者：翟晓强[1] 赵军[1] 李和程[1] 张栋[1] 张连栋[1] 王子明[1] 种铁[1] 

机构地区：[1]西安交通大学第二附属医院泌尿外科,西安710004

出　　处：《临床泌尿外科杂志》2017年第12期942-945,共4页Journal of Clinical Urology

摘　　要：目的:探讨经尿道精囊镜检查术治疗常染色体显性多囊肾病(ADPKD)相关的顽固性血精及射精管梗阻性无精子症的疗效。方法:2015年1月~2016年10月,我院共收治ADPKD相关精囊疾病7例,其中以顽固性血精为主要表现3例,以梗阻性无精子症为主要表现4例。收集上述7例患者的临床资料,进行回顾性分析。结果:患者盆腔磁共振主要表现为双侧精囊扩张,精囊的平均宽度为25mm,长度为45.8mm。除精囊扩张外,3例顽固性血精患者中2例出现单侧精囊内信号异常,1例精囊结石;4例梗阻性无精子症患者中1例表现为射精管囊肿,1例单侧精囊内信号异常。所有患者均行精囊镜检查术,平均手术时间35(20~50)min。所有患者均获得随访,以顽固性血精为主要表现的3例患者术后3个月血精症状均消失;以梗阻性无精子症为主要表现的4例患者术后3个月复查,2例精液质量恢复正常,2例精液量仍<1.5ml,离心后可见少量精子。术后6个月,1例患者配偶成功妊娠。结论:ADPKD可累及精囊、附睾等男性生殖器官,累及精囊时患者可表现为梗阻性无精子症或顽固性血精。经尿道精囊镜检查术治疗表现为顽固性血精及梗阻性无精子症的常染色体显性多囊肾病安全、有效。Objective：To evaluate the utility of transurethral seminal vesiculoscopy for treatment of autosomal dominant polycystic kidney disease（ADPKD）related persistent and recurrent hemospermia and azoospermia secondary to ejaculatory duct obstruction（EDO）.Method：From January 2015 to October 2016,seven cases of ADPKD,including three cases of persistent and recurrent hemospermia as the main symptom and four cases of obstructive azoospermia as the main symptom were treated in our hospital.Clinical data of the patients were collected and retrospectively analyzed.Result：Pelvic magnetic resonance（MR）of the patients showed bilateral seminal vesicle dilatation,the average width and length of the seminal vesicle were 25 mm and 45.8 mm,respectively.In addition to bilateral seminal vesicle dilatation,two of three patients with persistent and recurrent hemospermia showed the typical changes of signal intensity in seminal vesicle,and the other one patient showed calculus of seminal vesicle.One of four patients with azoospermia showed ejaculatory duct cysts,and another one patient showed unilateral signal abnormalities in seminal vesicle.Transurethral seminal vesiculoscopy was performed in all cases.The mean operative time was 35（range,20-50）min.All patients were followed up,hemospermia was disappeared at three months postoperatively in persistent and recurrent hemospermia cases.Among four cases of obstructive azoospermia,semen parameters of two cases were back to normal at three months postoperatively,including pregnancy of one of their spouse.Semen volume was still less than 1.5 ml in another two cases.However,there was a small amount of sperm in their seminal fluid after centrifugation.Conclusion：ADPKD can affect the epididymis,seminal vesicle and other male reproductive system.Transurethral seminal vesiculoscopy could be an effective and feasible treatment for ADPKED,who present with persistent and recurrent hemospermia and obstructive azoospermia.

关 键 词：常染色体显性多囊肾病 精囊镜 血精症 无精子症 

分 类 号：R697.4[医药卫生—泌尿科学] R692[医药卫生—外科学]