经尿道射精管切开术治疗远端射精管梗阻引起的精囊囊肿

目的:进一步探讨由于射精管梗阻引起的精囊囊肿的治疗。方法:采用精液分析(包括精液的量、pH值、果糖的测定)、经直肠指检和B超检查的方法。于2005年11月～2006年12月,12例诊断为射精管梗阻引起的精囊囊肿[(2.3±1.1)cm]患者,采用经尿道电切镜切开、切除梗阻的射精管,直到见到有乳白色的精液排出的方法治疗。结果:12例精囊囊肿患者术后1、3、12个月复查囊肿明显缩小[(1.0±0.8)cm,P<0.05]。没有发现明显的并发症。10例在术后3个月复查精液时检出活精子,12例精液量手术前后分别为(1.6±0.8)ml、(3.5±1.2)ml(P<0.05)结论:经尿道电切术治疗射精管梗阻引起的精囊囊肿是一种简单、有效的方法。     

不同年龄对精子凋亡率及DNA完整性影响的研究

目的:探讨不同年龄阶段精子凋亡率、精子DNA完整性及精液基本参数与年龄是否存在相关性。方法:随机选取在我科因女方因素行体外受精-胚胎移植男性精液标本104例,按男方年龄分为3组,年龄<35岁组43例、35～39岁组31例、≥40岁组30例,按WHO手册第4版手工分析精液常规参数,流式细胞术(FCM)结合FITC-Annexin V/PI荧光染色检测精子凋亡率,吖啶橙荧光染色检测精子DNA完整性。结果:①3组精液量[(2.87±0.89)ml vs(2.98±1.09)ml vs(2.65±0.95)ml]、精子浓度[(60.40±25.43)×106/ml vs(69.74±28.33)×106/ml vs(55.97±27.22)×106/ml]无显著性差异(P>0.05),≥40岁组前向运动精子百分率[(39.00±8.35)%]减少,与<35岁组[(48.72±9.89)%]和35～39岁组[(45.65±10.55)%]相比,差异有显著性(P<0.01);≥40岁组正常形态精子百分率[(11.11±8.26)%]与<35岁组[(16.43±8.75)%]相比,差异有显著性(P<0.01)。②精子凋亡在不同年龄组人群均有一定发生率,≥40岁组精子凋亡率为[(11.82±5.77)%],高于<35岁组[(7.04±3.50)%]和35～39岁组[(9.42±4.73)%],与<35岁组相比结果有统计学意义(P<0.01);≥40岁组DNA完整精子百分率降低[(75.52±10.60)%],与<35岁组[(86.55±5.60)%]和35～39岁组[(81.39±8.94)%]相比,差异有显著性(P<0.01);③男性年龄与精子凋亡百分率呈正相关(P<0.01),与前向运动精子、DNA完整精子百分率呈负相关(P<0.01)。结论:男性年龄增加可能导致前向运动精子百分率减少,正常形态精子百分率降低,精子凋亡百分率增加,DNA完整精子百分率性降低,在生育过程中,男性年龄应引起关注。     

精浆中MIP-1α与TNF-α测定的临床意义

目的:观察巨噬细胞炎性蛋白1α(MIP-1α)与肿瘤坏死因子α(TNF-α)含量在男性不育患者精浆中的变化,以及对精子的影响。方法:应用酶联免疫吸附试验(ELISA)与放射免疫分析(RIA)方法分别对110例不育男性和30例生育男性精浆MIP-1α与TNF-α含量进行测定,并与精液中精子浓度、活力、活动率、白细胞含量和血液中抗精子抗体(AsAb)情况进行对比分析。结果:不育症组精浆MIP-1α与TNF-α含量[(179.45±24.54)pg/ml和(4.66±2.01)ng/ml]均明显高于生育组[分别为(89.64±13.27)pg/ml和(2.90±1.23)ng/ml],两者之间均存在显著性差异(P<0.01),而且以少精子症不育症组最为显著。精浆MIP-1α与TNF-α含量在不育症组的精子活力不良组[(196.04±23.54)pg/ml和(5.31±2.47)ng/ml]、活动率下降组[(210.39±21.43)pg/ml和(5.14±2.61)ng/ml]、WBC精液组[(203.14±24.65)pg/ml和(5.28±2.66)ng/ml]和血清AsAb阳性组[(234.05±27.60)pg/ml和(5.63±2.31)ng/ml]中均分别高于精子活力正常组[(154.22±26.38)pg/ml和(3.94±2.09)ng/ml]、活动率正常组[(139.87±27.62)pg/ml和(4.11±2.26)ng/ml]、非WBC精液组[(155.76±21.42)pg/ml和(4.04±2.24)ng/ml]和血清AsAb阴性组[(124.85±23.56)pg/ml和(3.69±2.15)ng/ml],两者之间均存在显著性差异(P<0.05或P<0.01),而且均以血清AsAb阳性组增高最为显著。结论:精浆MIP-1α与TNF-α含量与精子数量和功能之间密切相关,检测精浆MIP-1α与TNF-α含量可以判断男性不育症患者的状态,帮助临床进行有价值的治疗。     

精液/精子质量与复发性流产关系的病例对照研究

目的:分析精液常规参数与复发性流产间的关系。方法:采用1∶1配对病例对照研究,比较复发性流产患者配偶与健康体检男性间的精液相关参数。结果:相对于对照组,病例组的精液量[(1.95±1.11)mlvs(2.74±1.43)ml]、精子浓度[(48.68±20.07)×106/ml vs(59.26±25.35)×106/ml]、b级精子百分率[(12.07±3.34)%vs(16.18±6.74)%]、果糖含量[(1.73±0.64)g/L vs(2.21±0.75)g/L]、顶体酶活性[(84.34±26.69)U/mg prot vs(94.20±26.35)U/mg prot]、α-葡糖苷酶(α-GLU)[(36.28±15.98)U/ml vs(44.45±12.54)U/ml]和酸性磷酸酶(ACP)[(68.55±35.45)U/ml vs(84.78±51.10)U/ml]的含量较低(P<0.05),头部畸形精子百分率[(47.36±4.59)%vs(46.50±6.32)%]、尾部畸形精子百分率[(7.56±2.27)%vs(7.28±3.10)%]和弹性硬蛋白酶[(885.64±1 272.30)ng/ml vs(661.08±764.64)ng/ml]的含量较高(P<0.05);判别分析结果显示,精液量、b级精子百分率、混合畸形精子百分率、果糖含量、α-GLU含量和ACP含量可用于复发性流产男性精液/精子质量的判断。结论:常规精液/精子质量相关检测对于评价复发性流产精液因素具有一定的意义,但需要综合分析,特异性不够;精液/精子质量相对较差与复发性流产发生相关。     

季节因素对供精志愿者精液冷冻前后相关参数的影响

目的:本研究旨在了解季节因素对供精志愿者冷冻前后精液参数及前向运动精子冷冻复苏率的影响。方法:6414份精液样本均来自2006年9月～2008年6月在浙江省人类精子库捐精的1135例供精志愿者,年龄22～32岁;按取精时间划分为春、夏、秋、冬季组;对所有精液标本均进行精液常规分析,对其中达到精子库冷冻标准的精液进行分装、冷冻,并进行复苏后的精液常规分析。结果:精液量春季最多[(2.92±1.17)ml],明显高于夏、秋、冬3个季节[(2.71±1.07)、(2.74±1.15)、(2.83±1.15)ml],有显著性差异(P均<0.05);精子密度秋季最高[(105.60±39.76)×106/ml],明显高于春、夏、冬3个季节[(101.18±40.16)×106/ml、(93.54±35.10)×106/ml、(101.29±38.37)×106/ml],有显著性差异(P均<0.05);前向运动精子百分率春季最高[(58.49±10.04)%],明显高于夏、秋、冬3个季节[(57.60±8.97)%、(56.76±9.63)%、(56.60±8.56)%],有显著性差异(P均<0.05);夏季精液的前向运动精子冷冻复苏率最低[(66.98±15.68)%],明显低于春、秋、冬3个季节[(69.04±14.26)%、(69.35±13.42)%、(69.31±15.11)%],有显著性差异(P均<0.05);春季精液冷冻复苏后前向运动精子密度最高[(28.82±11.29)×106/ml],明显高于夏、秋、冬3个季节[(25.57±10.08)×106/ml、(26.97±9.68)×106/ml、(26.21±9.47)×106/ml],有显著性差异(P均<0.05);夏季精液冷冻复苏后前向运动精子百分率最低[(39.75±9.48)%],明显低于春、秋、冬3个季节[(41.87±9.28)%、(41.44±8.45)%、(41.03±9.13)%],有显著性差异(P均<0.05)。结论:季节因素对供精志愿者精液参数及前向运动精子冷冻复苏率有影响,春季精液量多、前向运动精子百分率高、冷冻复苏率高、冷冻复苏后前向运动精子密度高,是捐精的最佳季节。     

无症状性前列腺炎对精液参数的影响

目的:探讨无症状性前列腺炎对精液参数的影响。方法:对已诊断无症状前列腺炎的152例患者按EPS中的WBC水平进行分组:A组(WBC+～++)和B组(WBC+++～++++);并设立健康正常的个体作为对照组(C组)。检测指标包括:精液量、pH值、液化时间、精子浓度、精子存活率、a级精子百分率、正常形态精子百分率、WBC计数与相关的炎症细胞因子等。结果:精液参数中液化时间、a级精子百分率(%)和正常形态精子百分率(%):A组(24.5±5.2)min、(20.0±4.1)、(10.5±4.8)和B组(30.4±5.0)min、(10.0±3.8)、(7.5±4.2)与C组(18.5±5.3)min、(32.3±4.5)、(17.8±3.6)相比,以及B组与A组相比,差异均有显著性(P<0.001),而pH值、精液量、精子存活率、精子浓度:A组(7.6±0.3)、(3.0±1.1)ml、(56.0±6.0)%、(65.9±11.3)×106/ml,B组(7.7±0.3)、(2.8±1.2)ml、(52.3±6.3)%、(62.5±10.3)×106/ml和C组(7.5±0.2)、(2.9±1.2)ml、(62.1±5.3)%、(87.7±10.1)×106/ml差异均无显著性(P>0.05)。B组精液中IL-1β(58.64±30.82)pg/ml、TNF-α(50.57±27.48)pg/ml与C组IL-1β(17.68±5.65)pg/ml、TNF-α(23.50±4.80)pg/ml比较,显著上升(P<0.001)。结论:无症状性前列腺炎对精液主要参数有明显影响。     

肾移植对尿毒症患者生精功能的影响

目的:探讨尿毒症患者肾移植后睾丸生精功能的改变。方法:比较30例男性尿毒症患者,肾移植前后精液参数变化及精子超微结构改变。结果:肾移植术后3个月精子活力与移植前比较显著升高[(70.08±2.86)%vs(36.04±8.01)%,P<0.01],活率显著增加[(76.15±3.75)%vs(39.27±4.14)%,P<0.01],运动速度显著加快[(16.80±1.11)μm/svs(8.43±2.01)μm/s,P<0.01]。精子超微结构发现,肾移植后支持细胞、顶体及线粒体的结构趋向正常。结论:肾移植可显著改善尿毒症患者的生精功能。     

少弱精子症和正常生育男性精液中尿激酶及其受体含量的研究

目的:通过研究精子正常和异常男性精浆和精子中尿激酶及受体含量差异,以了解尿激酶及受体与男性生育力的关系。方法:采用双抗体夹心ELISA法测定22例正常生育男性和44例少弱精子症男性精浆和精子中尿激酶及受体的含量。结果:①正常男性精浆尿激酶平均含量为(4 803.69±602.78)mU/L,与少弱精子症组[(4 061.35±736.23)mU/L]相比,差异有显著性(P<0.01)。正常生育男性精子尿激酶平均含量为(30.29±3.16)mU/106个精子,与少弱精子症组[(20.51±4.2)mU/106个精子],差异有显著性(P<0.01)。②正常生育男性精子尿激酶受体平均含量为(12.97±3.11)mU/106个精子相比,与少弱精子症组[(6.09±1.45)mU/106个精子]相比,差异有显著性(P<0.01)。③精子和精浆中尿激酶含量和精子活率和活力呈显著正相关。结论:尿激酶和男性生育力相关,少弱精子症和正常生育男性精液中尿激酶及其受体含量存在差异。     

精道内镜技术诊治顽固性血精216例临床分析

目的:探讨应用经尿道精道内镜技术诊断与治疗顽固性血精及伴发射精管梗阻的手术技巧和长期疗效。方法:回顾性分析2009年1月~2015年5月经我院多种药物保守治疗(1个月以上)无效、病史超过6个月的216例顽固性血精患者临床资料:入院后行术前常规检查及经直肠B超、盆腔MRI检查,对两侧可疑精囊及其周围病变进行初步定位,然后采用经尿道精道内镜技术进行诊断和治疗,分析其临床特征、影像学改变、精道内镜手术技巧,并对其长期疗效进行随访观察。结果:平均手术操作时间33(20~65)min,平均失血量5(0~10)ml,平均住院天数3.8(3~5)d。211例患者成功进行精囊镜或精道远端区域内镜检查和治疗,3例患者存在原发性或继发性双侧精囊萎缩或射精管开口发育异常等未能成功进镜,2例患者确诊为前列腺癌而被剔除。189例患者成功随访,25例患者失访,平均随访时间42.5(6~72)个月。189例患者术后均未发生附睾炎、直肠损伤、逆行性射精、尿失禁等严重并发症。94.2%(178/189)患者术前血精症状均在2~4周内消失,随访期内未再出现血精症状。仅5.8%(11/189)患者于术后血精消失5~20个月后复发,其中6例患者再次做精囊镜处理,随访3个月血精症状消失;余下患者经口服药物治疗后症状仍反复出现。8例患者自述射精快感强度较术前稍降低。18例术前血精伴不育者术后精液质量显著提高,术后1~6个月复查精液常规示精液量1.5~4.5ml,精子浓度(21.5~63.0)×106/ml,A+B级精子比例为27.4%~66.7%,其中38.9%(7/18)患者术后6~24个月配偶自然怀孕。结论:引起顽固性血精最常见原因可能是射精管区域的囊肿或射精管开口的炎性狭窄所致的射精管梗阻,偶伴精道结石形成。对于保守治疗无效的顽固性血精,精道远端梗阻等症状者,应用精道内镜技术进行诊断和治疗是安全有效的微创措施。     

吸烟对大鼠生精细胞发育影响的研究

目的:探讨吸烟对大鼠生精细胞发育的影响。方法:自制吸烟机将大鼠制成被动吸烟模型,大鼠随机分成被动吸烟组(A、B组各10只)及相应对照组(C、D组各10只),A、B组被动吸烟8周,随后处死A组及相应对照组C组大鼠;B组停止被动吸烟后与其相应对照组D组继续观察48 d后处死。流式细胞术(FCM)检测各组大鼠生精细胞周期,放免法测定血睾酮(T)、黄体生成素(LH)水平,HE染色观察睾丸组织结构变化,透射电镜观察睾丸超微结构改变。结果:与C组比较,A组大鼠精子、精子细胞[(18.76±3.58)%]和初级精母细胞[(5.71±1.18)%]明显减少(P均<0.01),而精原细胞[(55.98±5.35)%]增加(P<0.01),增殖指数降低(P<0.01)。A组大鼠生精小管壁变薄,层次减少,生精小管内精原细胞减少,精母细胞固缩。间质细胞内质网扩张脱颗粒,高尔基复合体减少,支持细胞脂滴和溶酶体增多。A组大鼠T、LH水平低于C组(P均<0.01)。B组大鼠停止被动吸烟后,精子、精子细胞、初级精母细胞比例和增殖指数上升,T、LH水平升高,但仍低于D组。结论:吸烟导致大鼠睾丸生精上皮损伤及间质细胞和支持细胞受损,同时伴有T和LH水平的下降,延缓生精细胞增殖,停止吸烟后生精功能有逐渐恢复的趋势。     

Transurethral endoscopic treatment for chronic hematospermia caused by müllerian duct cyst and ejaculatory duct obstruction

Between June 1997 and September 1999, we performed transurethral unroofing (TUUR) in three patients with hematospermia that recurred repeatedly for one year or more. Patient 1 (48 years old) and Patient 2 (59 years old) were diagnosed as having müllerian duct cysts that communicated with the left ejaculatory duct, and Patient 3 (36 years old) as an ejaculatory duct obstruction with the right ejaculatory duct dilation. A mixture of water-soluble contrast medium and indigocarmine blue dye was injected into the cysts and the ejaculatory duct cavity after incision of the vas deferens in Patients 1 and 3, and by cyst puncture under transrectal ultrasound (TRUS) guidance in Patient 2. Then the urethra was incised between the bladder neck and the verumontanum using a Collins' hot knife electrode, and spouting of the dye from the incision was judged to indicate successful unroofing. In Patient 2, safe and simple TUUR was possible by identifying the cyst location and its distance from the knife electrode under TRUS guidance. Hematospermia resolved after surgery in all three patients and there has been no recurrence for 1.3-3.5 years (mean: 2.6 years). Thus, TUUR was effective for treating chronic hematospermia caused by müllerian duct cyst and ejaculatory duct obstruction. For safe and reliable performance of this treatment, TRUS guidance and injection of the dye into the cyst and ejaculatory duct cavity can be recommended.     

经直肠超声引导下精囊穿刺灌注治疗顽固性血精长期疗效观察

目的:评价经直肠超声(TRUS)引导下经会阴精囊穿刺灌注抗生素治疗顽固性血精的长期疗效。方法:入选12名患者,年龄(36.4±10.8)岁,病程(13.9±6.4)个月。取得前列腺按摩液(EPS)并进行细菌培养。在TRUS引导下经会阴穿刺抽吸影像异常侧精囊液(SVF)进行细菌培养。根据EPS细菌培养和药敏试验结果选择抗生素,细菌培养阴性者选择广谱抗生素,在TRUS引导下穿刺精囊进行灌洗和冲洗。1个月后复查时如血精未消失,则再次穿刺灌药。以后每3个月随访1次。结果:TRUS发现精囊和/或射精管异常影像者9例,包括精囊和/或射精管扩张7例;精囊壁增厚3例;精囊壁钙化或精囊结石3例;副中肾管囊肿1例。7例SVF培养阳性,其中耐甲氧西林金黄色葡萄球菌4例,耐甲氧西林凝固酶阴性葡萄球菌、大肠埃希菌、奇异变形杆菌各1例。随访10例,随访时间(31.4±5.7)个月,中位时间31.5个月。治疗后从未复发3例,曾经复发7例;末次随访时2例仍有持续发作,8例未发作。结论:TRUS引导下精囊穿刺灌注抗生素治疗顽固性血精有一定疗效。     

Imaging diagnosis, transurethral endoscopic observation, and management of 43 cases of persistent and refractory hematospermia

The goal of this study was to explore minimally invasive transurethral imaging and surgery for the treatment of severe, persistent hematospermia in cases that were refractory to conservative treatments. The study included 43 patients (aged 22-77 years; average, 44.6 years) with long-lasting, severe hematospermia, accompanied by discomfort or pain in the lumbosacral or perineal region, dysuria, frequent micturition, decreased semen volume, and/or azoospermia. Patient symptoms had persisted for 1 to 10 years (average, 5.3 years). Computed tomography or magnetic resonance imaging of each patient was evaluated, and transurethral surgery was performed. The causes of hematospermia were identified in all 43 patients, and their ejaculatory duct obstruction or seminal vesiculitis was successfully treated. No serious intraoperative or postoperative complications occurred. Pathologic analyses revealed that all of the resected or biopsied seminal vesicle tissues had chronic nonspecific inflammation in the seminal vesicle wall, and no tumors were identified. Preoperative symptomology of hematospermia disappeared in all patients followed up for 2 to 30 months (average, 16 months). A single patient experienced recurrence at 11 months and had a second minimally invasive surgery that was curative. A total of 95.3% (41 of 43) of the patients experienced normal orgasmic intensity after surgery. Magnetic resonance imaging is a valuable and accurate diagnostic method for the identification of causative factors underlying hematospermia. Transurethral dilation of ejaculatory ducts, incision of the verumontanum or the distal end of the ejaculatory ducts, and incision or resection of the relevant cysts represent simple, safe, and reliable approaches for the management of refractory cases of hematospermia that do not respond to conservative treatments.     

Hematospermia (Ejaculatory duct calculus) – An unusual cause

Hematospermia is a common harmless condition that invokes a lot of anxiety to the patient. Calculous obstruction of the ejaculatory duct is an unusual cause of hematospermia. We report one such case of hemospermia due to an ejaculatory duct calculus that was diagnosed with TRUS. An endoscopic approach should be attempted to manage all such cases.     

顽固性血精病因和治疗初探

目的 :探讨顽固性血精的病因特点和影响治疗的因素 ,评价经直肠超声 (TRUS)引导下经会阴穿刺抽吸精囊液和灌注抗生素诊治顽固性血精的有效性。　方法 :入选 12例病人 ,平均年龄 (36 .4± 10 .8)岁 ,平均病程 (13.9± 6 .4 )个月。病人先行前列腺按摩 ,取得前列腺液 (EPS)并进行细菌培养。在TRUS引导下经会阴穿刺抽吸影像异常侧精囊液 (SVF)进行细菌培养和细胞学检查。根据EPS细菌培养和药敏试验结果选择抗生素 ,如细菌培养阴性则选择广谱抗生素 ,在TRUS引导下穿刺精囊进行灌注和冲洗。 1个月后复查时如血精未消失 ,则再次穿刺灌药。以后每 3个月随访 1次。　结果 :B超发现精囊异常影像位于左侧 4例 ,右侧 3例 ,双侧 2例 ,未见异常 3例。异常影像包括 :精囊或 和射精管扩张 7例 ;精囊壁增厚 3例 ;精囊壁钙化或精囊结石 3例 ;副中肾管 (M櫣ｌｌｅｒｉａｎｄｕｃｔ)囊肿1例。 7例SVF培养阳性 :耐甲氧西林金黄色葡萄球菌 (MRSA) 4例 ,耐甲氧西林凝固酶阴性葡萄球菌 (MRCNS)、大肠埃希菌、奇异变形杆菌各 1例。此 7例病人中 5例SVF和EPS细菌培养结果相同。在TRUS引导下经会阴穿刺精囊灌注抗生素并冲洗 ,7例灌注 1次 ,5例灌注 2次。随访 10例 ,平均 (16 .7± 5 .9)个月 ,6例未复发 ,4例仍反复发作。　结论 :以     

Ejaculatory duct obstruction

Ejaculatory duct obstruction presents with infertility, pain, or hematospermia. Partial or functional forms of ejaculatory duct obstruction can be difficult to diagnose. Transrectal ultrasound has replaced formal vasography as the first-line diagnostic test but is not specific. Adjunctive procedures such as seminal vesicle aspiration, seminal vesiculography, and chromotubation further delineate the diagnosis. Using an evidence-based approach, this article reviews how best to approach the diagnosis and treatment of ejaculatory duct obstruction.     

Transurethral incision for hematospermia caused by ejaculatory duct obstruction

Hematospermia is supposed to be derived from pathological conditions in the seminal vesicle, prostate, testis, epididymis, or urethra. A recent advance in diagnostic procedures has demonstrated the seminal vesicle, the prostate, and midline cyst as potential sources of hematospermia. The authors describe a case of hematospermia caused by ejaculatory duct obstruction, in which a transurethral technique was successful. A 51-year-old male was referred to the authors' clinic with a chief complaint of hematospermia. Transurethral ultrasonography showed a cystic lesion surrounded with hyperechoic area in the middle of the prostate. Vasography demonstrated the distal dilation of the ejaculatory duct. Magnetic resonance imaging demonstrated a high signal intensity area in the middle of the prostate. Urethrocystoscopy showed an enlarged cystic lesion with an orifice at the prostatic urethra, which was incised endoscopically. There was no complication observed postoperatively. Seven months after the technique, hematospermia resolved completely. A midline cyst should be considered a cause of hematospermia and the incidence of such cysts may be higher than that previously recognized. The transurethral technique is expected to be a successful treatment approach.     

经尿道精囊镜技术诊治血精的临床研究

目的 探讨经尿道精囊镜技术对顽固性血精的诊断和临床应用价值.方法 筛检2010年6月至2011年7月,对16例顽固性血精患者,年龄22~47岁,平均35.5±5.3岁;病程3~48个月,平均6.6±3.6个月,采用了经尿道精囊镜诊断和治疗.结果 手术全部成功,时间25~45 min,平均30.2±8.4 min,平均随访期为8.3个月(6～12个月),术后随访至今,仅1例精囊炎性出血患者术后3个月血精复发,治疗后半年内没有血精症状出现,视为治愈,本组治愈率为93.75%.结论 经尿道精囊镜检操作简单,创伤小,可作为顽固性血精的有效诊治方法.     

经直肠实时超声引导精囊镜在治疗射精管梗阻性无精子症的效果分析

目的:探讨经直肠实时超声引导精囊镜(TRUS-SVS)治疗射精管梗阻性无精症的可行性和有效性.方法:回顾2016年6月至2018年6月我院术前确诊为双侧射精管梗阻性无精子症且经射精管开口和前列腺小囊进入精囊均失败40例患者临床资料,采用TRUS-SVS进入精囊,分析手术进镜成功率、手术时间、并发症和治疗效果,评估TRU...     

精囊镜血精诊治29例并文献复习

目的 探讨经尿道精囊镜检诊治顽固性血精的安全性及可行性.方法 回顾性分析本院自2008年9月至2013年8月开展经尿道精囊镜检诊治的29例顽固性血精患者的临床资料,结合文献复习顽固性血精的治疗方法.患者年龄26 ～ 55岁,平均42岁,血精病程6～48个月,平均12个月,药物和物理治疗无效.结果 29例精囊镜检均成功,手术时间分别为20～ 75 min,平均35min.精囊镜检示慢性炎症11例,结石5例,息肉3例,射精管梗阻扩张3例,未发现明显病变7例.无尿道和精囊损伤等并发症.术后随访,其中17例患者血精症状消失,1例术后9个月再发血精,呈间歇性发作,持续随访中.结果表明29例顽固性血精患者采用精囊镜检治疗,近期疗效显著,远期治疗有效率为55.2％.结论 经尿道精囊镜检操作简单,创伤小,可作为顽固性血精的有效诊治方法之一.