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。

Long-Term Efficacy of TRUS-Guided Transperineal Needle Aspiration and Irrigation on Persistent Hematospermia

OBJECTIVE: To evaluate the long-term efficacy of transrectal ultrasonography (TRUS)-guided transperineal needle aspiration and irrigation for persistent hematospermia. METHODS: Included in the study were 12 patients with persistent hematospermia, aged (36.4 +/- 10.8) years, and with a course of the disease of (13.9 +/- 6.4) months. After the expressed prostatic secretion (EPS) by prostatic massage cultured, the patients received TRUS-guided transperineal needle aspiration for seminal vesicle fluid (SVF) for bacteriological examination. For the EPS positive patients, antibiotics were selected according to the drug sensitivity assay and injected into the abnormal seminal vesicle (SV) via TRUS-guided transperineal needle puncture. The treatment was repeated one month later for those still with hematospermia. The patients were followed up every three months. RESULTS: Abnormal images were found in the SV and/or ejaculatory duct in 9 cases, including SV and/or ejaculatory duct dilation, SV wall thickening, calcification or calculi of SV, and müllerian duct cyst. SVF cultures were positive in 7 cases, including 4 cases of methicillin-resistant Staphylococcus aurous (MRSA), 1 case of methicillin-resistant coagulase-negative staphylococcus (MRCNS), 1 case of E. Coli, and 1 case of Proteus mirabili. All the patients were treated by TRUS-guided transperineal injection of certain antibiotics into SV. Ten of them were followed up for (31.4 +/- 5.7) months. Hematospermia disappeared in 3 cases and relapsed at least once in the other 7. The last follow-up showed hematospermia recurrence in 2 cases. CONCLUSION: TRUS-guided transperineal irrigation of antibiotics into SV is effective to a certain extent for persistent hematospermia.