摘要
【目的】探讨4.5/6.5F输尿管硬镜应用于血精症诊疗中的临床价值。【方法】回顾性研究2014年3月至2019年8月于本院行精囊镜检查和治疗的血精症患者30例,患者平均年龄42.9岁(18~65岁)。所有患者术前均行血清前列腺特异性抗原(prostate specific antigen,PSA)、前列腺及精囊超声、盆腔MRI或CT等检查。28例应用4.5/6.5F输尿管硬镜作为精囊镜,在超滑镍钛导丝引导下进行镜检。生理盐水冲洗精囊腔,冲洗出暗红色精浆样物质、血性液体和细小精囊结石,较大的结石采取钬激光碎石后取出。2例伴阴茎勃起后尿道溢血或肉眼血尿患者发现后尿道曲张静脉团,予以电切除。【结果】经射精管开口进镜9例,经前列腺小囊内射精管侧壁短路进镜11例,经精阜切开显露射精管进镜8例。26例完成双侧精囊镜手术,2例完成单侧精囊镜手术。术后随访10.5个月(3~13个月)。2例后尿道曲张静脉切除术后症状消失,所有患者血精症状均获得缓解。2例患者术后分别于血精缓解后6个月和3个月出现复发,但血精症状较术前轻,其中1例经口服抗生素治疗后缓解,1例1个月后自行缓解。1例患者出院后1周内出现附睾炎,无发热,经治疗后缓解。所有病例无术后直肠损伤、逆行射精和尿失禁等并发症。【结论】采用4.5/6.5F输尿管硬镜用于精囊镜检诊断和治疗血精症,安全有效,操作简单,并发症少,值得推广。
【Objective】To investigate the value of 4.5/6.5 F ureteroscope in the diagnosis and treatment of hematospermia.【Methods】A retrospective study was conducted on 30 patients with hematospermia who underwent seminal vesicle examination and related treatment in our hospital from March 2014 to August 2019. The average age of the patients was 42.9 years old(18-65 years old). All patients underwent the examination of serum prostatic specific antigen(PSA), prostate and seminal vesicle ultrasound, pelvic MRI or CT before surgery. Twenty-eight cases were examined with guidence of the nitinol core wire in the application of a ureteroscope of 4.5/6.5 F as a seminal vesiculoscopy. The seminal vesicle cavity was rinsed with normal saline. Kermesinus plasma-like material, bloody fluid and fine seminal vesicle calculi in seminal vesicle cavity were flushed out. Larger calculi could be removed by holmium laser lithotripsy.There were two patients with urethra hemorrhage or gross hematuria after erection who were found to have varicose veins in the posterior urethra and underwent electric resection.【Results】There were 9 cases entering the seminal vesicles through the nature openings of the ejaculatory ducts while 11 cases through the by-passes of the lateral walls of the ejaculatory ducts in the prostatic vesicle and 8 cases through the ducts revealed by incision of the verumontanum. A total of 26 patients underwent bilateral seminal vesicle surgeries and 2 patients underwent unilateral surgeries. Postoperative follow-up was conducted for 10.5 months(3-13 months). Symptoms disappeared after varicose phlebectomy of the posterior urethra in 2 patients, and hemospermia was relieved in all 28 patients. Hemospermia recurrence occurred in 2 patients after 6 months and 3 months from the remission, respectively. Their hemospermia was less severe than that before the operation. According to the two patients, one was relieved after oral antibiotics treatment, and the other was relieved spontaneously after 1 month. One patient developed epididymitis within 1 week after discharge without fever, which was relieved after treatment. There was no postoperative rectal injury, retrograde ejaculation and urinary incontinence in all patients.【Conclusion】The 4.5/6.5 F ureteroscopy can be used in the diagnosis and treatment of hematospermia, and its safety and efficacy are relatively high, which is worth promoting.
作者
刘翔宇
赵耀瑞
朱鸣阳
王健
LIU Xiang-yu;ZHAO Yao-rui;ZHU Ming-yang;WANG Jian(Logistics University of PAP,Tianjin 300309,China)
出处
《武警后勤学院学报（医学版）》
CAS
2020年第7期21-24,共4页
Journal of Logistics University of PAP（Medical Sciences）
关键词
输尿管镜
精囊镜
血精症
Ureteroscopy
Seminal vesiculoscopy
Hematospermia
