CAJ | 학술논문

目的：探讨联合应用软性和硬性输尿管镜行精囊镜检查在顽固性血精诊疗中的应用。方法回顾性分析该中心2012年6月-2014年12月间收治的23例顽固性血精患者的临床资料，完善相关检查后，联合应用奥林巴斯半硬性输尿管镜(F8/9.8 Olympus )及软性输尿管镜(F5.3/8.4 Olympus URF-P5)行经前列腺小囊的精囊镜手术治疗。结果23例患者均顺利完成手术，手术时间21~65 min,平均时间（35.1±8.2）min。单纯性精囊炎症7例（30.4%），精囊炎合并前列腺小囊结石5例（21.7%），合并精囊结石6例（26.1%），合并前列腺小囊开口狭窄2例（8.7%）,合并射精管瘢痕狭窄2例（8.7%），合并射精管囊肿1例（4.3%），均给予相应处理。术后随访6月，1例复发抗炎对症治疗后消失。结论联合应用软性和硬性输尿管镜行精囊镜检查能直视下观察到精囊腔内的情况，有助于明确顽固性血精的病因并进行相关治疗，充分利用了现有设备和成熟的输尿管镜技术，是可行的诊断和治疗顽固性血精的方法。
목적：탐토연합응용연성화경성수뇨관경행정낭경검사재완고성혈정진료중적응용。방법회고성분석해중심2012년6월-2014년12월간수치적23례완고성혈정환자적림상자료，완선상관검사후，연합응용오림파사반경성수뇨관경(F8/9.8 Olympus )급연성수뇨관경(F5.3/8.4 Olympus URF-P5)행경전렬선소낭적정낭경수술치료。결과23례환자균순리완성수술，수술시간21~65 min,평균시간（35.1±8.2）min。단순성정낭염증7례（30.4%），정낭염합병전렬선소낭결석5례（21.7%），합병정낭결석6례（26.1%），합병전렬선소낭개구협착2례（8.7%）,합병사정관반흔협착2례（8.7%），합병사정관낭종1례（4.3%），균급여상응처리。술후수방6월，1례복발항염대증치료후소실。결론연합응용연성화경성수뇨관경행정낭경검사능직시하관찰도정낭강내적정황，유조우명학완고성혈정적병인병진행상관치료，충분이용료현유설비화성숙적수뇨관경기술，시가행적진단화치료완고성혈정적방법。
Objective To evaluate the role of trans-utricular seminal vesiculoscopy using flexible combined with rigid ureteroscope in the diagnosis and treatment of persistent hemospermia. Methods A retrospective analysis was conducted on the clinical data of 23 cases with persistent hematospermia admitted in Peking University Wu Jieping Urology Center from June 2012 to December 2014. After related examinations, trans-utricular seminal vesiculoscopy was performed in all patients by using a F8/9.8 semi-rigid ureteroscope ( Olympus ) combined with a F5 . 3/8 . 4 flexible ureteroscope ( Olympus URF-P5 ) . Results All the 23 patients accomplished the surgery successfully with the average operative duration of (35.1±8.2)minutes (ranged from 21 to 65minutes). Among them, simple seminal vesiculitis was in 7 cases (30.4%), seminal vesiculitis combined with prostatic utricle calculi in 5 cases(21.7%), combined with seminal vesicle stone in 6 cases(26.1%), combined with narrow opening of prostatic utricle in 2 case (8.7%), combined with scar stricture in ejaculatory ducts in 2 cases (8.7%), combined with ejaculatory duct cyst in 1 case (4.3%). All cases were given corresponding treatment during the surgery and followed up for 6 months after the operation.Hematospermia was recurred in 1 patient, and disappeared after anti-inflammatory treatment. Conclusion Flexible combined with rigid ureteroscope for trans-utricular seminal vesiculoscopy is a feasible diagnostic and treatment method for persistent hemospermia, it makes full use of existing equipment and the mature ureteroscopy technique, and can observe the status of seminal vesicle lumen, and is conducive to determining the pathogeny and relative treatment.