摘要
目的:分析总结精囊镜在顽固性精囊炎诊断与治疗中的有效性与安全性。方法:回顾性分析我院2016年2月～2017年12月采用小儿输尿管镜诊治顽固性精囊炎15例患者的临床资料,年龄22～62岁,因反复血精或下腹部、会阴部不适就诊,病程均超过3个月,入院前同时口服喹诺酮类和二或三代头孢菌素1个月以上无效或症状反复复发。术前均完善经直肠前列腺、精囊B超及盆腔CT或MRI。术中使用F6/7.5小儿输尿管镜直视下进入前列腺小囊,检查小囊,斑马导丝或镍钛诺导丝引导下通过射精管开口或射精管内侧管壁开窗进入精囊,检查精囊后予以冲洗、取石、止血,必要时活检。结果:15例患者中14例顺利进入精囊(其中2例只完成一侧手术),1例合并前列腺小囊结石,取出结石后因炎症粘连较重而未能成功进入精囊。12例顺利进入双侧精囊,2例仅进入一侧精囊,其中1例黏膜活动性出血,2例合并精囊结石,剩余各例黏膜炎性充血。所有患者均未出现直肠损伤、逆行射精、附睾炎及尿失禁等并发症。1例患者术后出现横纹肌溶解综合征,经支持对症处理后康复出院。15例手术患者均获得随访,平均随访13(3～24)个月,血精患者症状均消失。下腹会阴疼痛症状患者3例中1例明显缓解,2例部分缓解,加用坦索罗辛及抗生素1个月后其中1例症状明显缓解。结论:经尿道精囊镜技术是治疗顽固性精囊炎的一种有效的治疗方法,但需由内镜技术经验丰富的医师操作,可提高手术成功率,降低并发症的发生率。
Objective:To analyze and summarize the efficacy and safety of the technique of transurethral seminal vesiculoscopy using apediatric ureteroscope in the diagnosis and management of refractory seminal vesiculitis.Method:We retrospectively analyzed 15 cases of refractory seminal vesiculitis examined and treated by transurethral pediatric ureteroscope from February 2016 to December 2017.The patients ranged in age from 22 to 62 years old and all had a disease course of over 3 months,admitted due to recurrent hematospermia or pain and discomfort in lower abdomen or perineum after one month of quinolone combined with second or third generation cephalosporin administration.All patients underwent transrectal ultrasound or CT/MRI preoperatively.F6/7.5 pediatric ureteroscope entered and checked the prostatic utricle under direct vision.The seminal vesiculoscope passed through the opening of ejaculatory duct or perforation of the lateral wall of ejaculatory duct via guidance of zebra or titanium-nickel wire and finally got to the seminal vesicle.Then we irrigated seminal vesicle,removed calculus,stopped bleeding and did a biopsy.Result:Fourteen of 15 patients were operated successfully.One patient failed the operation because of serious inflammation.Only one side of seminal vesicle was operated in 2 of 14 patients.Mucosal active hemorrhage in 1 patient,prostatic utricle stones in 1,seminal vesicle stones in 2 and mucosal inflammatory hyperemia in 11 were found intraoperatively.No retrograde ejaculation,rectal injury,urinary incontinence,or epididymitis was observed in all patients.Rhabdomyolysis syndrome occurred in one patient postoperatively and the patient was discharged from hospital after in-time treatment was provided.Fifteen patients were all followed up for 3 to 24 months(mean 13 months).The hematospermia and pain symptom disappeared in all and1 of 3 patients respectively.Pain symptom was partly relieved in 2 patients and one of them got obviously relieved after medication of tamsulosin and antibiotics for 1 month.Conclusion:Transutricular seminal vesiculoscopy was an effective treatment choice for refractory seminal vesiculitis.We advise the technique should be performed by endoscopic technique experienced physician in order to improve the success rate of operation and reduce the incidence of complications.
作者
邹慈
于德新
毕良宽
王毅
闵捷
王进有
耿浩
王琦
杨超
方露
ZOU Ci;YU Dexin;BI Liangkuan;WANG Yi;MIN Jie;WANG Jinyou;GENG Hao;WANG Qi;YANG Chao;FANG Lu(Department of Urology,Second Affiliated Hospital of Anhui Medical University,Hefei,230601,China)
出处
《临床泌尿外科杂志》
2019年第3期227-230,共4页
Journal of Clinical Urology
基金
国家自然基金资助项目(编号81572507)
关键词
血精
精囊病变
精囊镜
hematospermia
seminal vesicle lesion
seminal vesiculoscopy
作者简介
通信作者:于德新,E-mail:yudx_urology@126.com.
