摘要
目的探讨采用可视穿刺经皮肾镜行精囊镜检查的可行性和安全性。方法回顾性分析2016年3月至2018年1月采用可视穿刺经皮肾镜行精囊镜检查的32例血精症患者的临床资料。年龄（38．8±8．7）岁（27-60岁）。病程（7．1±3．3）个月（2-15个月）。彩色多普勒超声检查示精囊腺回声欠均匀或精囊腺扩张。MRI检查示精囊腺出血或精囊腺异常信号。患者术前采用左氧氟沙星或莫西沙星抗感染治疗≥1个月，效果不佳。手术采用蛛网膜下腔麻醉，患者取截石位。以F4．8可视穿刺经皮’肾镜进入后尿道，找到精阜，采用注射器缓慢推水，以保持良好的视野。寻找精阜两侧的射精管开口并进入，如无法在正常位置找到射精管开口，则进镜至前列腺小囊内，寻找可能存在的小囊内异位开口；如仍未发现射精管开口，则在小囊内5、7点位置，以镜头探查并穿刺进入射精管侧壁。可视穿刺经皮肾镜在穿刺过程中可以有效避开血管，减少对组织的损伤。本组32例中，14例从精阜射精管开口进入，2例从前列腺小囊内射精管开口进入，16例从前列腺小囊内5、7点穿刺进入。进入射精管及精囊后，探查精囊腺各个腔隙。术中发现前列腺小囊结石5例，精囊腺结石7例，精囊腺息肉1例，精囊腺积血19例。对于结石或息肉，更换为F8外鞘后，采用F1．9套石篮取出结石或摘除息肉，以生理盐水、0．02％呋喃西林冲洗精囊腺，然后每侧精囊腺灌注16万U庆大霉素；对于积血，清理后同样以生理盐水、呋喃西林冲洗，并灌注庆大霉素。结果本组32例手术均顺利完成，手术时间（55．0±11．3）min（35-82min）。术中无直肠、尿道损伤。术后导尿管留置2d，术后第4天出院。术后1例拔除尿管后出现轻微血尿，自行好转；1例出现附睾炎，予抗感染治疗后好转。6例结石行成分分析，5例为六水磷酸镁铵，1例为二水草酸钙、一水草酸钙及碳酸磷灰石的混合性结石。1例息肉病理诊断为炎性息肉。术后第4、6、8、12周复查。术后8周时，24例血精消失；8例血精好转，予口服抗生素治疗。术后12周时，6例血精消失，2例仍有血精。结论采用可视穿刺经皮肾镜行精囊镜检查，操作性强，手术安全，近期疗效确切。
Objective To detect the feasibility and safety of applying all-seeing needle in transurethral seminal vesiculoscopy. Methods Retrospective analysis was made with clinical data of 32 patients of hemospermia treated with transurethral seminal vesiculoscopy using all-seeing needle from March 2016 to January 2018. The patients ＂age was （38.8 ＋ 8.7） years （27 -60 years） and the course of disease was （7.1 _＋ 3.3 ） months （2 - 15 months）. Ultrasound before operation showed heterogeneous echo, or expansion of the seminal vesicle. MRI showed hemorrhage of the seminal vesicle, or abnormal signal of the seminal vesicle. Patients had levofloxaein or mosisasin anti-infection therapy more than one month and remained uncovered. The operation was performed under subarachnoid anesthesia, and the patients took the lithotomy position. The F4.8 all-seeing needle entered the posterior urethra, the verumontanum was found, and the saline was slowly pushed with a syringe to maintain a clear view. Then, the ejaculatory duct opening was searched on both sides of the verumontanum. If the ejaculatory duct opening cannot be found in the normal position, we entered the needle into the prostatic utricle to find the possible ectopie opening. If the ejaculatory duct opening was still not found, at the 5 and 7 o ＂clock positions in the prostatic utricle, the needle was probed and punctured into the side wall of the ejaculatory duct. Visible puncture with all-seeing needle can effectively avoid penetrating blood vessels and reduce damage to tissues during puncture. In this study, the ejacalatory duct opening got accessed on the verumontanum in 14 cases, through ectopic openings within the prostatic utricle in 2 cases, and through artificial establishment in 5 and 7 o＇ clock positions within prostatic utriele in 16 cases. After entering the ejaculatory duct and seminal vesicle, we explored the cavities of the seminal vesicles. For stones or polyps, after replacing the outer sheath to F8, F1.9 stone retrieval basket was applied to remove stones or polyps, followed by rinsing the seminal vesicles with normal saline, 0. 02% nitrofurazone, and then 160,000 units of gentamicin into each seminal vesicle. For hemorrhage, after clearing up the blood, seminal vesicles were also washed with normal saline, nitrofurazone, and perfused with gentamiein. In the operation, prostatic utricle stone was found in 5 cases, and seminal vesicle stone was found in 7 cases. One case of seminal vesicle polyp was observed, and in 19 cases, seminal vesicle hemorrhage was seen. Results All the operations were accomplished successfully, the operation time was （ 55.0 -＋ 11.3 ） rain （35 - 82 rain ）. There was no rectal injury or urethral injury during operation. The postoperative catheter was removed at 2 days postoperatively and the patients discharged on the 4th day after surgery. The length of hospital stay was （6.3±0.7 ） days （5 -7 days）. One patient had mild hematuria after removal of the urethral catheter and got improved spontaneously;one case developed epididymitis,which improved after anti-infective treatment. 6 cases made stone analysis, with 5 cases of magnesium ammonium phosphate hexahydrate, and 1 case of calcium oxalate dihydrate, calcium oxalate monohydratc and carbonate apatite mixed stones. One case of polyp was diagnosed by pathologists to be an inflammatory polyp. Follow-up was performed at 4,6,8, and 12 weeks after surgery. Hemospermia was cured in 24 cases,relieved in the other 8 cases at 8-week follow-up, who received oral antibiotic treatment afterwards. At the 12-week follow-up, the rest 6 cases in 8 got hemospermia recovered,with 2 cases still uncovered. Conclusions All-seeing needle is user-friendly and safe in transurethral seminal vesieuloscopy, with reliable short -term efficacy.
作者
吴科荣
罗爱平
殷玮琪
谢国海
陈雪琴
王国耀
程跃
Wu Kerong;Luo Aiping;Yin Weiqi;Xie Guohai;Chen Xueqin;Wang Guoyao;Cheng Yue(Department of Urology,Ningbo First Hospital,Ningbo 315000,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第11期852-855,共4页
Chinese Journal of Urology
关键词
血精
精囊镜
可视穿刺经皮肾镜
Hemospermia
Seminal vesiculoscopy
All-seeing needle
