经前列腺小囊射精管切开术治疗顽固性血精症的初步体会（附23例报道 .doc

经前列腺小囊射精管切开术治疗顽固性血精症的初步体会（附23例报道） 李建伟，王芳 福建医科大学附属第二医院泌尿外科，福建，泉州，362000 【摘要】 目的：探讨经前列腺小囊射精管切开术治疗顽固性血精症的可行性和安全性；方法：2010.1月~2014.12月期间我院收治血精症患者23例，平均年龄47.3±6.5岁（38-61岁），血精持续时间平均5.8±1.7个月（3.5-27个月），术前行保守治疗时间3.4个月（3-5.6个月），主要表现为反复发作的血精，伴有射精痛者12例，会阴痛、睾丸痛患者4例。所有患者均行经前列腺小囊射精管切开术，术后随访3~6个月； 结果：所有23例患者均顺利完成手术，平均手术时间28±4.2分钟(20-42分钟)，术后平均住院时间1.5天（1-3天），其中单纯性精囊炎22例，其中精囊炎合并精囊结石6例、乳头状精囊上皮瘤1例，不明原因2例。无尿失禁，直肠损伤等手术并发症发生。术后1~3个月内患者血精症状均消失，其中1个月内血精症状消失的有19例，在1~2月间消失的有3例，在2~3月间消失的有1例。术后随访时间3~6个月，无血精复发者；结论：经前列腺小囊射精管切开术对顽固性血精症患者是一种安全有效的治疗方法，但否具有临床推广应用价值还需大样本的临床对照研究进行评价。 【关键词】 顽固性血精症，精囊镜，射精管切开术，钬激光 Transprostatic-utricle’s Holmium laser incision of ejaulcatory duct in the treatment of 23 cases of refractory hemospermia LI Jian-wei，WANG Fang Department of urology, the second affiliated hospital of Fujian medical university,quanzhou,Fujian 362000.China 【Abstract】 objective: to assessed whether this transprostatic-utricle’s Holmium laser incision of ejaculatory duct is feasible and effective in the diagnosis and treatment of refractory hemospermia; Methods Totally 23 patients with refractory hemospermia underwent transprostatic-utricle’s incision of ejaculatory duct With holmium laser incision through ureteroscopy from 2010.1 to 2014.12. Age of patients ranged from 38 to 61 years (mean age 47.3±6.5 years). The patients’ symptoms ranged in duration from 3.5 to 27 months (mean duration 5.8±1.7 months).all patients were monitored for 3-6 months. Results All 23 patients successfully underwent transprostatic-utricle’s Holmium laser incision of ejaulcatory duct. which revealed 21 cases of seminal vesiculitis，6 seminal calculi，1 seminal vesicle polyps．The operative time was 15 to 35 minutes (mean28±4.2). Symptoms of hemospermia disappeared after one month in 19 patients ,after two months in three patient and after three months in one patient. Three patients with painful ejaculation could completely be relieved postoperation. There were no postoperative complications.hemospermia of no patients were