输尿管软镜在精囊疾病诊疗中的体会

摘要/Abstract

摘要： 目的：探讨输尿管软镜在精囊疾病诊治中的应用。方法：经尿道逆行插入输尿管硬镜，逆行进入射精管及精囊，再更换输尿管软镜对精囊疾病的患者进行检查和治疗。结果：该组15例患者有12例成功进入双侧精囊，3例进入一侧精囊，手术时间20～55 min，平均（30.2±8.5）min。10例有不同程度的射精管开口狭窄或结石梗阻；5例精囊有血凝块，3例有精囊结石，1例发现黏膜炎性病变，1例射精管口囊肿，行相应处理。术后随访3～14个月，平均随访（7.3±2.4）个月，8例血精1个月后消失，1例射精痛术后明显缓解，3例会阴部不适明显缓解，1例无精症患者术后3个月精液常规即可查及精子；1例术后出现附睾炎，经抗感染、对症治疗好转。结论：输尿管软镜可以直接观察射精管及更完整的精囊内部，少漏诊，诊疗率高，且操作简单、并发症少、术后恢复快，有较好的临床应用价值。

关键词: 输尿管软镜, 精囊镜, 精囊疾病

Abstract: Objective： To explore the application of flexible ureteroscopy in the diagnosis and treatment of seminal vesicle disease. Methods： Retrograde transurethral insertion of rigid ureter scope， retrograde travel to the ejaculatory duct and seminal vesicles， and replaced by flexible ureteroscopy for examination and treatment of patients with seminal vesicle disease. Results： Among the 15 patients in this group， 12 successfully entered bilateral seminal vesicles and 3 entered unilateral seminal vesicles. The operation time was 20-55 min， with an average of（30.2±8.5）min. 10 cases had different degrees of ejaculatory duct stenosis or stone obstruction； 5 cases had seminal vesicles blood clots， 3 cases had seminal vesical stones， 1 case had mucosal inflammatory lesions， 1 case had ejaculatory duct cysts， and had the corresponding treatment. After 3-14 months follow-up， with average follow-up of （7.3±2.4） months， 8 cases of blood sperm disappeared after 1 month， 1 cases of ejaculation pain significantly relieved after operation， 3 case of perineal discomfort significantly relieved， 1 case of azoospermia sperm can be routinely investigated in semen 3 months after surgery， 1 cases of epididymitis after surgery， which improved by anti-infection， symptomatic treatment. Conclusion： The flexible ureteroscope can directly observe the interior of the ejaculatory duct and the more complete seminal vesicle， with less missed diagnosis， high diagnosis and treatment rate， simple operation， less complications， and rapid postoperative recovery， and has good clinical application value.

Key words: Flexible ureteroscope, Seminal vesiculoscopy, Seminal vesicles diseases

. 输尿管软镜在精囊疾病诊疗中的体会[J]. 中国医药导刊, 2019, 21(9): 567-569.

参考文献

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[2] Xu B, Niu X, Wang Z, et al. Novel methods for the diagnosis and treatment of ejaculatory duct obstruction[J] . BJU international,2011 , 108 ( 2 ) : 263 - 266 .
[3] 李立, 钟红兴. 梗阻性无精子症的临床诊断和外科治疗[J]. 临床医学, 2012, 32(2): 106- 108.
[4] 张卫星, 贾东辉, 王瑞, 等. 两种手术方式治疗射精管梗阻临床疗效分析[J]. 中国男科学杂志, 2013, 27(4): 43- 45.
[5] Han CH, Liang Q, Dong BZ, et al. The transurethral seminal vesiculoscopy in the diagnosis and treatment of the seminal vesicle disease.[J] . Cell Biochemistry & Biophysics,2013 , 66 ( 3 ) : 851 - 853 .
[6] Wang HF, Ye HM, Xu CL, et al. Transurethral seminal vesiculoscopy using a 6F vesiculoscope for ejaculatory duct obstruction:Initial experience[J]. J Androl, 2012(33): 637-640
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[8] Xing CY，Zhou XM，Xin L，et al． Prospective trial comparing transrectal ultrasonography and transurethral seminal vesiculoscopy for persistent hematospermia[J].International journal of urology,2012 , 19 ( 5 ) : 437 - 442 .
[9]夏永强，叶敏，于春晓，等．精囊镜技术的改进与临床应用［J］．中华泌尿外科杂志，2015，36 ( 2) : 148 － 151．
[10]靳风烁，李彦锋．血精及射精管梗阻的精囊镜诊治技术［J］．临床泌尿外科杂志，2015，30( 1) : 1 － 5．
[11]刘边疆，李杰，李鹏超，等．应用精囊镜治疗顽固性精囊炎的初步体会［J］．中华泌尿外科杂志，2014，35 ( 10) :774 － 777．
[1] 涂响安, 赵良运, 赵亮, 等. 经尿道射精管切开术治疗射精管梗阻的效果(附60 例报告)[J]. 北京大学学报(医学版), 2011, 43(4):559- 561.
[2] Xu B, Niu X, Wang Z, et al. Novel methods for the diagnosis and treatment of ejaculatory duct obstruction[J] . BJU international,2011 , 108 ( 2 ) : 263 - 266 .
[3] 李立, 钟红兴. 梗阻性无精子症的临床诊断和外科治疗[J]. 临床医学, 2012, 32(2): 106- 108.
[4] 张卫星, 贾东辉, 王瑞, 等. 两种手术方式治疗射精管梗阻临床疗效分析[J]. 中国男科学杂志, 2013, 27(4): 43- 45.
[5] Han CH, Liang Q, Dong BZ, et al. The transurethral seminal vesiculoscopy in the diagnosis and treatment of the seminal vesicle disease.[J] . Cell Biochemistry & Biophysics,2013 , 66 ( 3 ) : 851 - 853 .
[6] Wang HF, Ye HM, Xu CL, et al. Transurethral seminal vesiculoscopy using a 6F vesiculoscope for ejaculatory duct obstruction:Initial experience[J]. J Androl, 2012(33): 637-640
[7]Li YF，Liang PH，Sun ZY，et al． Imaging diagnosis, transurethral endoscopic observation, and management of 43 cases of persistent and refractory hematospermia[J].Journal of andrology,2012 , 33 ( 5 ) : 906 - 916 .
[8] Xing CY，Zhou XM，Xin L，et al． Prospective trial comparing transrectal ultrasonography and transurethral seminal vesiculoscopy for persistent hematospermia[J].International journal of urology,2012 , 19 ( 5 ) : 437 - 442 .
[9]夏永强，叶敏，于春晓，等．精囊镜技术的改进与临床应用［J］．中华泌尿外科杂志，2015，36 ( 2) : 148 － 151．
[10]靳风烁，李彦锋．血精及射精管梗阻的精囊镜诊治技术［J］．临床泌尿外科杂志，2015，30( 1) : 1 － 5．
[11]刘边疆，李杰，李鹏超，等．应用精囊镜治疗顽固性精囊炎的初步体会［J］．中华泌尿外科杂志，2014，35 ( 10) :774 － 777．

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