精囊镜检术在顽固性血精症诊治中的临床应用

The Clinical Application of Seminal Vesicle Microscopy Flush Treatment in the Treatment of Refractory Hemospermia Syndrome

摘要: 目的：探讨精囊镜检冲洗治疗术在顽固性血精症诊治中的临床应用价值和技术前景。方法：106例临床诊断为顽固性血精症的患者，术前常规直肠指检，精液培养加药敏，直肠B超，精囊MRI平扫，血PSA等检查排除精囊肿瘤、结核和前列腺癌等；经尿道以F6输尿管镜插入精囊进行镜检，冲洗精囊内陈旧性血块和炎性分泌物，扩张狭窄的射精管及精囊腺开口；合并结石用套石囊 + 钬激光碎石后取出，合并囊肿用钬激光去顶减压，术中再以抗生素生理盐水反复冲洗精囊并保留灌注。结果：有92例成功完成双侧精囊镜检冲洗治疗术，14例仅完成单侧精囊镜检冲洗术，其中，1例为右侧输精管发育缺如，1例为左侧精囊发育缺如；术中无直肠穿孔和尿道损伤，术后无逆行射精、附睾睾丸炎和尿道直肠瘘等并发症发生；术后1~3月复查MRI，精囊腺体积缩小，囊腔无扩张和结石；治疗后随访6~18月，有8例患者血精症状复发，其中，有2例再次做了精囊镜检冲洗治疗术，另外6例经抗炎解痉治疗后血精消失。结论：经尿道F6输尿管镜进行精囊镜检冲洗术是治疗顽固性血精症安全有效的微创方法之一，值得临床应用推广。

Abstract: Objective: To investigate the clinical value and technical prospects of seminal vesicle microscopy and flushing-probing-flushing treatment refractory hemospermia syndrome. Method: 106 patients with refractory blood azoospermia, preoperative examinations including routine digital rectal examination, spermoculture and drug sensitivity test, the rectal B ultrasound, seminal vesicle MRI scan, blood PSA and other tests to exclude seminal vesicle cancer, tuberculosis and prostate cancer and so on. Transurethral ureteroscopy F6 inserting seminal vesicle to microscopy, flushing old blood clots and inflammatory secretions in seminal vesicle, dilatating narrow ejaculatory duct and seminal vesicle orifice, seminal vesicle calculus was taken out with stone basket and Holmium laser lithotripsy; seminal vesicle cyst was decorticated with Holmium laser, intranperative repeatedly washed and reservation sperfusion seminal vesicle with antibiotics and saline. Results: 92 patients successful completed the bilateral seminal vesicle microscopy, 14 patients completed only one said seminal vesicle microscopy, in which 1 case whose right side seminal vesicle was absence, and 1 case whose left side seminal vesicle was absence; there was no intraoperative rectal perforation and urethral injury. No retrograde ejaculation, epididymis, orchitis ,urethral fistula and other complications were found postoperative. All patients were re-checked by MRI scan after operation 1 to 3 months, found that these seminal vesicle volumes were reduced, no cysts expansion and stones; in the follow-up for 6 to 18 months post-treatment, 8 patients were hemospermia recurrence, in which 2 cases treated again with seminal vesicle microscopy, the rest of 6 cases treated with anti-inflammatory and antispasmodic therapy and after all these hematospermia symptoms were disappear. Conclusion: The seminal vesicle microscopy flush treatment with transurethral ureteroscopy is one of the safe and effective minimally invasive methods to treat refractory hemospermia syndrome, which should be worthy to clinical application and promotion.