CAJ | 학술논문

目的探讨应用精囊镜治疗顽固性精囊炎的实用性和有效性. 方法 2007年12月至2011年6月我科收治精囊炎患者74例,均伴有反复发作的血精及下腹部或会阴部疼痛不适.入院前全身应用抗炎药物及局部理疗至少3个月无效.术前均行经直肠B超、精囊MRI扫描,排除精道畸形和肿瘤.全身麻醉下经尿道射精管开口插入7F或9F精囊镜,观察尿道、前列腺、射精管及精囊,明确精囊炎的诊断.通过精囊镜工作通道注入生理盐水反复冲洗精囊腔,注入并保留左氧氟沙星注射液于精囊腔中.若有精囊结石采用钬激光碎石取石. 结果 68例患者成功接受了双侧精囊镜手术,其中5例合并精囊结石予以钬激光碎石取石术.平均手术时间(35± 10) min,平均住院时间3d.4例术后出现射精疼痛,给予口服抗感染药物和α受体阻滞剂,1周后缓解.2例术后出现附睾炎症状,给予抗感染治疗1周后治愈.6例患者未能进行双侧精囊镜手术,其中3例仅观察到单侧射精管开口并行同侧精囊镜手术,另3例未找到射精管开口.所有患者均未出现逆行射精、直肠损伤、尿道外括约肌损伤等并发症.术后随访6～12个月,61例患者血精消失,疼痛不适症状均有不同程度缓解甚至消失.另7例症状改善不明显. 结论应用精囊镜治疗顽固性精囊炎的临床效果好,操作简便,创伤小,恢复快.
목적 탐토응용정낭경치료완고성정낭염적실용성화유효성. 방법 2007년12월지2011년6월아과수치정낭염환자74례,균반유반복발작적혈정급하복부혹회음부동통불괄.입원전전신응용항염약물급국부리료지소3개월무효.술전균행경직장B초、정낭MRI소묘,배제정도기형화종류.전신마취하경뇨도사정관개구삽입7F혹9F정낭경,관찰뇨도、전렬선、사정관급정낭,명학정낭염적진단.통과정낭경공작통도주입생리염수반복충세정낭강,주입병보류좌양불사성주사액우정낭강중.약유정낭결석채용화격광쇄석취석. 결과 68례환자성공접수료쌍측정낭경수술,기중5례합병정낭결석여이화격광쇄석취석술.평균수술시간(35± 10) min,평균주원시간3d.4례술후출현사정동통,급여구복항감염약물화α수체조체제,1주후완해.2례술후출현부고염증상,급여항감염치료1주후치유.6례환자미능진행쌍측정낭경수술,기중3례부관찰도단측사정관개구병행동측정낭경수술,령3례미조도사정관개구.소유환자균미출현역행사정、직장손상、뇨도외괄약기손상등병발증.술후수방6～12개월,61례환자혈정소실,동통불괄증상균유불동정도완해심지소실.령7례증상개선불명현. 결론 응용정낭경치료완고성정낭염적림상효과호,조작간편,창상소,회복쾌.
Objective To investigate the practicality and effectiveness of transurethral seminal vesiculoscopy in treatment of intractable seminal vesiculitis.Methods A Total of 74 patients with seminal vesiculitis of recurrent hematospermia and pain and discomfort in lower abdomen or perineum were recruited from December 2007 to June 2011.Before admission,patients received systemic anti-inflammatory drugs and local physiotherapy for at least 3 months with poor treatment outcome.No abnormalities or tumors were observed in preoperative transrectal ultrasound or MRI.Under general anesthesia,transurethral 7 F or 9 F seminal vesiculoscopy was inserted into the bilateral ejaculatory duct openings and seminal vesicle cavities.The urethra,prostate,ejaculatory ducts and seminal vesicles were visualized to confirm the diagnosis of seminal vesiculitis.The ejaculatory duct was dilated by the endoscopy if stenosis or obstruction existed.Saline was injected through the working channel of the endoscopy to wash repeatedly the seminal vesicle cavities,followed by injection and reservation of levofloxacin solution in the seminal vesicle cavities.Holmium laser lithotripsy was performed if seminal vesicle calculi were present.Results Sixty-eight patients performed bilateral seminal vesiculoscopy successfully.The average operative time was 35± 10 minutes,and the average length of hospitalization was 3 days.Four patients had painful ejaculation after operation and relieved after oral admisstration of antibiotics and α-blockers.Two cases of postoperative epididymitis were cured after one week of antibiotics.No severe complications (such as retrograde ejaculation,rectal injury or urethral sphincter damage) were observed.Followed up for 6 to 12 months,the hematospermia of 61 out of 68 patients,disappeared.Conclusion Seminal vesiculoscopy for diagnosis and treatment of intractable seminal vesiculitis is accurate,effective,simple and minimally invasive.