输尿管精囊镜检在慢性精囊炎诊疗中的应用

目的:评价运用微创输尿管精囊镜诊治慢性难治性精囊炎及伴发疾病的临床疗效。方法:30例慢性难治性精囊炎患者的临床资料,单侧24例,双侧4例,2例进镜失败,其中20例伴有血精,5例伴有前列腺炎,3例合并精囊结石。利用逆行输尿管镜插管诊治并冲洗,观察其临床疗效。结果:手术时间14⁵2 min,平均(32±5)min,住院时间352 min,平均(32±5)min,住院时间3⁷ d,术后随访67 d,术后随访6¹0个月。2例进镜失败维持药物治疗;20例血精治愈,2例术后半年再发血精;8例射精疼痛基本消失,6例会阴部不适者术后缓解,5例前列腺炎治愈,1例好转,3例精囊结石治愈,1例残留,5例少精子患者术后610个月。2例进镜失败维持药物治疗;20例血精治愈,2例术后半年再发血精;8例射精疼痛基本消失,6例会阴部不适者术后缓解,5例前列腺炎治愈,1例好转,3例精囊结石治愈,1例残留,5例少精子患者术后6⁹个月内精液量较前明显提高,精子活力亦有所提高,术中、术后均无严重并发症出现。其中20例痊愈,7例好转,3例无效,有效率90.0%,痊愈率66.6%。结论:经尿道输尿管精囊镜能直视下检查精囊腔内情况,有助于查找难治性精囊炎及伴发疾病的病因并对症处理,而且并发症少,是慢性难治性精囊炎的有效治疗方法。

Application of ureteroscopy to diagnosis and treatment of chronic refractory seminal vesiculi-tis

Objective：To evaluate the clinical effect of minimally invasive transurethral ureteroscopy for the treatment of chronic refractory seminal vesicul-itis and the concomitant diseases .Methods：The therapeutic effects were retrospectively examined in 30 patients with chronic refractory seminal vesiculitis undergone minimally invasive transurethral ureteroscopy.Of the total patients,24 were unilateral and 4 bilateral involvement.Twenty were associated with hemospermia,5 with prostatitis and 3 with seminal vesicle stones.Results：The operative time ranged from 14 to 52 min with an average of （32 ±5）min, and the hospital stay was between 3 and 7 days.Two failure treatment were managed with drug intervention.Twenty cases with hematospermia were cured, and relapse occurred in 2 in half a year.Painful ejaculation was subsided in 8 cases,and genital discomfort recovered in 6 after operation.Prostatitis was cured in 5 cases,and improvement in 1.Seminal vesicle stones were successfully removed,and residual stones occurred in 1.Five patients with azoospermia were improved significantly between 6 and 9 months after operation,with increased volume of ejaculation.No intra-or post-operative complication occurred. In the total patients,20 were cured,7 improved and 3,failed.The effective rate was 90.0% and the recovery rate,66.6%.Conclusion：Transurethral uret-eroscopy can be performed easily with few complications and is an effective therapeutic approach to the chronic refractory seminal vesiculitis.