冷刀治疗血精.pptVIP

部分患者囊肿位于中线区域，与射精管及精阜无交通，切开囊肿其内未见血性液体，而是清亮无色液体。且囊肿各壁完整。未见与精囊的交通，此时。通过肛门挤压按摩精囊。囊肿壁外侧可见沿射精管溢出的血性精液，证实该类囊肿为Mullerian囊肿。导致射精管梗阻，引起血精。遂同上法切开扩大射精管并进行精囊的冲洗和观察。 结果 15例可见精阜较正常显著隆起、增大，6例精阜未见明显改变；明确存在偏离中线的射精管囊肿(Wolffian囊肿)者7例，其中左侧6例，右侧1例。 位于精阜深部中线区域的Mullerian囊肿或前列腺囊肿9例，其中，4例与双侧精囊及射精管无交通，提示符合Mullerian囊肿。5例于内壁的侧后方可见明显卵圆形裂隙状精囊开口，或被菲薄半透明膜状物覆盖的精囊开口。提示符合前列腺囊肿 讨论 术中注意事项和技巧主要是：(1)精阜的显著隆起一般意味着该区域存在明显梗阻，故可直接应用电刀切除隆起的精阜；(2)如切除精阜后。深面不能直接显露囊肿，或难以分辨射精管，需结合肛门内精囊按摩，使血性液体从射精管溢出，从而或插入导丝进行引导，或直接沿之小心向深部电切或冷刀挑开；(3)根据术中所见囊肿是否偏离中线，是否与精囊相沟通可鉴别囊肿的类型，并据情况行单纯切开、电灼或电切除处理；(4)对于较为深在的囊肿，需反复通过肛门指检的辅助确认电切的深度，避免损伤直肠；(5)如果是射精管囊肿，通过该囊肿通常仅能观察到一侧的精囊情况。需注意结合双侧精囊按摩，确认对侧精囊及射精管的通畅性，必要时可同时行对侧射精管切开；(6)对于存在与精囊无沟通的Mullerian囊肿处理后，需继续观察和探查双侧射精管的通畅性；(7)可应用输尿管镜对双侧射精管及精囊进行全面观察；(8)如有精囊囊肿，可行囊肿切开、电灼和电切除等处理。 阅读体会 冷刀适用于前列腺小囊囊肿（射精管囊肿、苗勒氏管囊肿）引起的血精患者 囊肿较大或表浅 电切与冷刀均可 目前国内外文献报道较多应用电刀切开，应用冷刀切开较少，通过“冷刀 ，血精 or射精管”等关键词相互联合搜索万方数据库及pubmed仅找到2篇文章。且发表时间较早。 冷刀在血精治疗中的应用 LOGO TRANSURETHRAL INCISION FOR HEMATOSPERMIA CAUSED BY EJACULATORY DUCT OBSTRUCTION 经尿道切开治疗射精管梗阻引起的血精 H. FUSE, R. NISHIO, K. MURAKAMI, and A. OKUMURA Department of Urology, Faculty of Medicine, Toyama Medical and Pharmaceutical University. Toyama. Japan Archives of Androhgy, 49:433^38, 2003 A 51-year-old male consulted our University Hospital with a chief complaint of hematospermia. Hematospermia had been recognized 4 months earlier and treated with coagulants at a local clinic, but the disorder was not improved. The patient had 2 children 一位51岁男性血精患者，病史4月余，局部使用促凝药，症状未改善。有2个孩子。 Macroscopic appearance of the semen was slightly red and 5- 10 red blood cells in the semen were detected per high-power field (x400). 精液高倍镜下5-10个红细胞，肉眼红色。 血常规、肝肾功能、细胞学检查、睾酮、LH、FSH、PSA均正常 Transurethral ultrasonography demonstrated a cystic lesion surrounded by hyperechoic lesion at the middle level of the prostate (Figure 1) vasography showed distal dilation of the ejaculatory duct (Figure 2). Magnetic resonance imaging (MRl) showed a high signal intensity lesion in the middl