慢性精囊炎119例病因及精囊镜治疗效果

目的通过对慢性精囊炎患者的病因分析及精囊镜治疗效果的评估,为临床诊治提供参考。方法回顾性分析2018年1月至2020年12月本院应用精囊镜诊治的119例慢性精囊炎患者的临床及随访资料,比较手术前后精囊腺和前列腺彩超影像学特征的变化,评价治疗效果。结果119例患者术前精液、前列腺液及尿液细菌培养中,仅见1例表皮葡萄球菌、1例溶血球菌。术中精囊液检测示细菌、解脲支原体及人型支原体均阴性。84例患者完成随访,经直肠彩超显示:术后精囊纵径(LD)、横径(APD)、体积及前列腺左右径均较术前减小(P<0.05),而前列腺上下径、前后径及体积的差异无统计学意义(P>0.05)。术后随访3~36个月,平均(15.2±8.5)个月:血精的治疗有效率80.9%(38/47),复发率19.1%(9/47);疼痛评分(VAS)较术前明显降低(P<0.01),疼痛缓解率86.7%(39/45)、复发率15.6%(7/45),未见直肠损伤、尿道括约肌损伤、逆行射精等并发症。结论慢性精囊炎可能多为非感染性炎症,而射精管部分或完全性梗阻是炎症的直接原因。精囊镜技术对顽固性血精症和会阴部疼痛症状均显示出较好疗效,且具有创伤小、并发症少的优点。

Etiological analysis and efficacy of transurethral seminal vesiculoscopy for chronic seminal vesiculitis

Objective To explore the etiology of chronic seminal vesiculitis and to evaluate the efficacy of transurethral seminal vesiculoscopy.Methods Clinical data of 119 patients with chronic seminal vesiculitis treated with transurethral seminal vesiculoscopy during Jan.2018 and Dec.2020 were retrospectively analyzed.The changes in seminal vesicle and prostate before and after surgery were compared.Results In preoperative bacterial culture of semen,prostate fluid and urine,Staphylococcus and Hemolytic Enterococci were found in 1 case.Perioperative examination of seminal vesicle fluid was negative for bacteria,ureaplasma urealyticum and mycoplasma hominis.Follow-up was completed in 84 patients.Color ultrasound showed the longitudinal diameter(LD),anterior-posterior maximum diameter(APD),and volume of the seminal vesicle and transverse prostate diameter were all reduced compared with those before surgery(P<0.05).But there were no significant differences in the axial prostate diameter,anteroposterior prostate diameter and volume of prostate(P>0.05).During the follow-up of 3-36 monthsaverage(15.2±8.5)months],80.9%(38/47)of patients with refractory hemospermia showed improvement,with a recurrence rate of 19.1%(9/47);86.7%(39/45)with perineal pain or discomfort showed improvement,with a recurrence rate of 15.6%(7/45).The visual analogue scale(VAS)was significantly lower than that before surgery(P<0.01).No complications such as rectal injury,urethral sphincter injury or retrograde ejaculation were observed.Conclusion Chronic seminal vesiculitis may be caused by non-infectious factors,and partial or complete obstruction of the ejaculatory duct is the direct cause of inflammation.Transurethral seminal vesiculoscopy is safe and effective for refractory hemospermia and perineal pain.