精囊镜术后双J管留置技术减少射精管瘢痕性梗阻复发  

Double J-tube indwelling after transurethral seminal vesiculoscopy reduces recurrence of ejaculatory duct obstruction

作　　者：庞昆 陈波 潘登 许浩 马雨阳 王海跞 王伟玲 PANG Kun;CHEN Bo;PAN Deng;XU Hao;MA Yu-yang;WANG Hai-luo;WANG Wei-ling(Department of Urology,Xuzhou Central Hospital/Xuzhou Clinical School of Xuzhou Medical University/Xuzhou Clinical School of Nanjing Medical University/Xuzhou Central Hospital Affiliated to Southeast University,Xuzhou,Jiangsu 221009,China;Peixian People's Hospital,Xuzhou,Jiangsu 221009,China)

机构地区：[1]徐州中心医院/徐州医科大学附属徐州临床学院/南京医科大学附属徐州临床学院/东南大学附属徐州市中心医院泌尿外科,江苏徐州221009 [2]沛县人民医院,江苏徐州221009

出　　处：《中华男科学杂志》2024年第8期681-686,共6页National Journal of Andrology

基　　金：中国博士后基金面上项目(2022M722674);江苏省妇幼保健协会项目(FYX202026);徐州市医学后备人才计划项目(XWRCHT20220009)。

摘　　要：目的:介绍一种尿道精囊镜检查(TSV)术后精囊内留置双J(D-J)管的方法,以期减少瘢痕相关性射精管阻塞(EDO)复发。方法:采用一项随机对照试验,比较TSV术后是否留置D-J管的手术治疗效果和并发症情况,以及复发率和复发时间。对患者的基线资料和TSV相关手术参数进行统计分析比较。其中,基线资料包括年龄、体质量指数(BMI)、术前抗生素使用情况、尿路相关病史、TSV相关手术参数包括手术时间以及术中和术后的并发症等。比较两组患者的术后并发症和术后住院天数,并重点对EDO的复发率及复发时间进行进一步分析。结果:本研究共纳入56例患者。其中,27例患者予留置D-J管(试验组)治疗,29例患者非留置D-J管(对照组)的常规TSV手术治疗。试验组和对照组的术后随访时间分别为(40.5±10.6)、(32.5±14.8)个月。两组患者在基线资料、术中和术后并发症以及术后住院天数方面无显著统计学差异(P>0.05),但手术时间和复发率有显著统计学差异(P均<0.05),试验组的复发率(18.5%)显著低于对照组(44.8%),两组中位复发时间接近(对照组21.0个月,试验组22.0个月)。结论:TSV术后留置D-J管的新方法,可以减少EDO术后复发。Objective:To introduce a surgical method involving the indwelling of double-J tubes(DJT)in the seminal vesicles after transurethral seminal vesiculoscopy(TSV)in order to reduce the recurrence of refractory ejaculatory duct obstruction(EDO).Methods:This randomized controlled trial included 67 EDO patients undergoing TSV in our hospitals,27 with(the trial group)and 29 without postoperative indwelling of DJTs in the seminal vesicles(the control group).We collected the general information on the patients and TSV-related parameters,including age,body mass index(BMI),preoperative use of antibiotics,history of urinary tract disease,operation time,hospital stay and intra-and postoperative complications,and performed comparative analyses particularly on the surgical effect,complications,recurrence rate and time to recurrence in the two groups of patients.Results:The patients in the trial and control groups were followed up for(40.5±10.6)and(32.5±14.8)months,respectively.There were no statistically significant differences in the baseline data,intra-and postoperative complications,and postoperative hospital days between the two groups(P>0.05).Compared with the controls,the patients in the trial group showed a significantly shorter operation time([62.8±6.1]vs[49.5±7.7]min,P<0.05)and a lower recurrence rate than the controls(18.5%vs 44.8%,P<0.05),but with no statistically significant difference in the median time to recurrence(21.0 mo vs 22.0 mo,P>0.05).Conclusion:The novel technique of indwelling double-J tubes in the seminal vesicles after TSV can significantly reduce the recurrence rate of refractory EDO.

关 键 词：经尿道精囊镜检查 梗阻性无精子症 D-J管 射精管梗阻 瘢痕性增生 

分 类 号：R697.26[医药卫生—泌尿科学]