摘要
目的探讨精囊镜探查术治疗顽固性血精的可行性、安全性及有效性。方法 2016年1月~2018年8月收治的顽固性血精病人31例,行不同手术入路的精囊镜探查术,术中给予精囊抗菌药物灌洗,清除精囊内血块、结石、炎症物质,术后随访6~12个月,观察术后效果及并发症。结果 12例经双侧射精管开口进镜,3例一侧经射精管开口进镜,一侧经前列腺小囊破壁途径进镜,11例经前列腺小囊破壁途径进镜,5例行精阜电切后进镜。21例术后3个月内血精完全消失,7例术后6个月内血精消失,3例术后1年血精仍未好转,1例术后发生急性附睾炎,治愈率为90.3%,并发症发生率为3.2%。结论精囊镜技术对顽固性血精的治疗安全、有效,一般不会造成严重的并发症。虽然经射精管开口途径为首选途径,但成功率低,经前列腺小囊破窗途径是重要的补充方法。虽然经前列腺小囊破窗途径及精阜电切均破坏了正常的射精管解剖结构,但并未见由此引起不良后果。
Objective To explore the feasibility, safety, and effectiveness of transurethral seminal vesiculoscopy(TSV) for the treatment of refractory hematospermia.Methods 31 patients with refractory hematospermia underwent transurethral seminal vesiculoscopy in different approaches between January 2016 and August 2018.Seminal vesicles were lavaged with antibiotics and blood clots, stones, and inflammatory substances were removed from the seminal vesicles.Postoperative follow-up was conducted for 6 to 12 months to observe the postoperative effect and the occurrence of complications.Results 12 patients underwent TSV successfully through bilateral ejaculatory duct openings, 3 patients underwent TSV through unilateral ejaculatory duct openings and contralateral prostatic utricle, 11 cases underwent TSV through prostatic utricle, 5 patients underwent TSV through resected verumontanum.In 21 cases, hemospermia disappeared completely within 3 months postoperatively.Hemospermia disappeared in 7 cases within 6 months after surgery.Hemospermia did not improve in 3 cases 1-year after surgery.Acute epididymitis occurred in one patient after operation.The cure rate was 90.3% and the incidence of complications was 3.2%.Conclusion Transurethral seminal vesiculoscopy is safe and effective in the treatment of refractory hematospermia, and generally does not cause serious complications.Although the opening of the ejaculatory duct is the preferred approach, the success rate is low.Although the prostatic utricle route and electrocution of verumontanium destroyed the normal anatomical structure of the ejaculatory duct, no adverse consequences were found.
作者
康延杰
秦帅锋
孙建涛
KANG Yanjie;QIN Shuaifeng;SUN Jiantao(Department of Urology,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang 471000,China)
出处
《临床外科杂志》
2021年第2期120-122,共3页
Journal of Clinical Surgery
关键词
血精
精囊镜
射精管
hemospermia
seminal vesiculoscopy
ejaculatory duct
