射精管囊肿的诊断和治疗

目的 探讨射精管囊肿的临床表现，影像学特点和治疗方法。方法 回顾性分析中国医科大学附属盛京医院泌尿外科收治的射精管末端囊肿患者15 例，结合手术前后生化检查和影像学资料分析手术疗效，并查阅相关文献综合评述射精管囊肿的诊治进展，探讨最优化的治疗方案。结果 13 例行经尿道射精管末端囊肿开窗术，2 例行射精管口切开术。典型患者可见切开囊肿后大量黄褐色或乳白色精液及积液涌出，6 例见细小黄褐色结石，电切液冲洗取出。2 例见血性沉积物，同法取出。精囊镜探查见射精管管道畅通，利用精囊镜体同期行射精管扩张术。患者术后均恢复良好，术后3 个月复查精液生化检查，均未见射精管囊肿复发。结论 射精管囊肿临床罕见，诊断困难，宜尽早手术。经尿道电切术治疗射精管末端囊肿具有创伤小、预后好等优势。术后应定期随访，注意复发。

Diagnosis and treatment of ejaculatory duct cyst

Objective To investigate the clinical characteristics, imaging features, diagnosis and treatment of ejaculatory duct cyst. Methods Fifteen cases of ejaculatory duct cyst in Shengjing Hospital of China Medical University were reported and literature was reviewed. Results Of the 15 patients, 13 cases were treated by transurethral fenestration of distal ejaculatory duct cyst and 2 cases were treated by transurethral incision of ejaculatory duct. After incision of cyst, a large number of yellowish or milky white semen and effusion were seen in the typical patients. In 6 cases, small brown stones were rinsed out. In 2 cases there was bloody sediment which was removed by the same method. Seminal vesicle microscopic examination showed that the ejaculation ducts were unobstructed. After operation, the patients recovered well. The patients were followed up for 6-36 months, and no recurrence was found. Conclusions Ejaculatory duct cyst is rare and difficult to diagnosis before operation, and it has diverse imaging manifestations. The transurethral resection is effective for its treatment with the advantages of little surgical trauma, rapid recovery and satisfactory effect.