精囊镜联合电切镜治疗射精管梗阻性无精子症19例剖析.docVIP

精囊镜联合电切镜治疗射精管梗阻性无精子症19例剖析 　　【摘要】目的：探讨精囊镜联合电切镜在射精管梗阻性无精子症中的应用。方法：分析作者2013年3月至2014年3月间收治的19例射精管梗阻性无精子症患者的临床资料，术前经取精器或手淫获得精液进行检查，示无精子症，经直肠前列腺、精囊腺及睾丸彩超检查，前列腺及精囊腺的CT检查，确诊为射精管梗阻性无精子症，腰麻下，利用Storz F48/6输尿管镜，配合电切镜行经前列腺小囊精囊镜检查。术后1个月起，连续复查精液常规。结果：18例患者顺利完成手术，1例因反复寻找射精管开口失败致手术无法完成。手术时间30～50min。术中发现射精管囊肿7例，射精管狭窄和或梗阻12例，精囊镜下精囊壁黏膜炎症性充血、散在出血点11例，精囊黏膜炎症性改变并腔内结石2例，均进行对症治疗。术后1个月起开始随访至术后12个月，除2例患者术后12个月精液常规未发现精子，其余患者在第1个月开始精液中均有不同程度精子的发现。19例患者术后均未出现附睾炎、逆行射精、尿道严重损伤、直肠损伤等并发症。结论：电切镜结合精囊镜经前列腺小囊治疗射精管梗阻性无精子症，先切除射精管囊肿及切开闭塞的射精管开口，经精囊镜扩张，在直视下通过精囊镜检查精囊腔内情况，解除了梗阻，冲洗了淤积的精囊内腔，既明确了无精子症的病因，又解除了梗阻，疏通了精道，该术式将电切镜和精囊镜技术有利结合，对射精管梗阻性无精子症的治疗具有重要的临床价值。 　　【关键词】电切镜；精囊镜；射精管；无精子症；治疗 　　Analysis of resectoscope combined with seminal vesiculoscopy in treating patients with ejaculatory duct obstruction azoospermiaLI Hu， HE Zuqiang， DONG Chaoxiong， HUANG Zifan， JIANG Tao， ZHONG Ziqiang， LUO Wenping . Department of Urology， Baiyun District First Peoples Hospital， Guangzhou 510400， Guangdong， China 　　【Abstract】Objectives： To explore effect of resectoscope combined with seminal vesiculoscopy in treating patients with ejaculatory duct obstruction azoospermia. Methods： Clinical data of 19 patients with ejaculatory duct obstruction azoospermia from March 2013 to March 2014 was analyzed. Preoperative sperm or masturbation get semen was examined as azoospermia. By transrectal prostate， seminal vesicle and testicular ultrasound， CT examination of the prostate gland and seminal vesicles， the diagnosis of ejaculatory duct obstruction azoospermia was confirmed. One month after the operation， continuous examinations on the semen were done. Results： Under lumbar spinal anesthesia， the Storz F4.8 / 6 ureteroscopy with the resectoscope through the prostate capsule seminal vesiculoscopy was done. Operations for 18 patients were successfully completed. Operation for a patient was not completed because of failures on finding ejaculatory duct. The operation time was 30-50 min. During the operation 7 cases of ejaculatory duct cysts，