曹志彬 夏琴琴 夏磊

摘要：目的  探討精囊镜技术在血精症诊治中的价值。方法  选取2016年3月～2018年12月上海健康医学院附属嘉定区中心医院收治的血精患者31例，根据患者精道开口情况分别选择经自然腔道、经前列腺小囊和射精管切除三种方式进镜。记录患者术前、术中和术后情况;随访患者术后血精改善情况，有无术后相关并发症。结果  31例血精症患者均顺利完成手术，手术时间30～55 min，平均手术时间（42.25±15.50）min，未发生直肠损伤、逆行射精、尿失禁、尿道狭窄、性功能减退等严重并发症;有6.45%患者经自然腔道进镜，90.32%患者经前列腺小囊进镜，其中17例利用导丝硬端直接破壁，11例用钬激光开窗，再经导丝引导下进入精囊，另3.22%经射精管切除进镜。术中发现8例患者存在结石，其中前列腺小囊内结石3例，精囊结石3例，前列腺小囊与精囊均有结石者2例，均为多发性小结石，结石直经1～8 mm。术后3个月，血精改善率为93.54%，会阴不适感改善率100.00%，排尿不适、下腹部改善率为90.91%。结论  精囊镜技术具有创伤小、疗效好和并发症少的优点，可作为血精外科诊疗手段的选择。

关键词：精囊镜;血精症;精囊炎;微创

中图分类号：R697+.4                                 文献标识码：B                               DOI：10.3969/j.issn.1006-1959.2019.18.067

文章编号：1006-1959（2019）18-0187-03

Abstract：Objective To explore the value of seminal vesiculoscopy technique in the diagnosis and treatment of hemospermia.Methods  31 patients with hemospermia admitted to Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences from March 2016 to December 2018 were selected. According to the patient's sacral opening， the natural cavity， the prostate capsule and the ejaculatory duct were selected. Ways to enter the mirror. The preoperative， intraoperative and postoperative conditions of the patients were recorded; the postoperative hemospermia improvement was followed up， and there were no postoperative complications. Results  31 patients with hemospermia successfully completed the operation， the operation time was 30～55 min， the average operation time was （42.25±15.50） min， and no serious complications such as rectal injury， retrograde ejaculation， urinary incontinence， urethral stricture and sexual dysfunction occurred. 6.45% patients underwent natural tunneling， and 90.32% patients underwent prostate capsules， 17 of which were directly broken by the hard end of the guidewire， and 11 were opened with holmium laser. Then， guided by the guide wire into the seminal vesicle， another 3.22% was removed into the mirror by the ejaculatory duct. In the operation， 8 patients were found to have stones， including 3 cases of small stones in the prostate capsule， 3 cases of seminal vesicle stones， 2 cases of stones with prostate capsule and seminal vesicle， all of which were multiple small stones， and the stones were straight through 1～8 mm. Three months after surgery， the improvement rate of blood sperm was 93.54%， the improvement rate of perineal discomfort was 100.00%， and the improvement rate of urination discomfort and lower abdomen was 90.91%.Conclusion  The seminal vesiculoscopy technique has the advantages of less trauma， good curative effect and less complications， and can be used as a choice for hemospermia.

Key words：Seminal vesiculoscopy;Hemospermia;Seminal vesiculitis;Minimally invasive

正常精液颜色为乳白色或乳黄色，当精液中混入了血液之后就变为血红色、淡红色或红褐色，称为血精。血精可分为显微镜下血精和肉眼血精，前者在精液外观上没有明显异常，但显微镜下可见数量不等的红细胞;后者肉眼即能够看到精液呈不同程度血色。炎症感染是血精最常见的病因，其它原因还有结石、囊肿、肿瘤、先天性畸形和医源性损伤等[1]。……