双镜联合诊治尿道源性血精血尿的临床体会
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摘要
目的探讨尿道源性血精血尿的临床特点及微创诊疗方法。方法回顾性分析2015年7月~2017年6月13例血精血尿患者的临床资料,年龄29~51岁,平均37.6岁,病史6个月~7年,中位数27个月。均有性生活后血精血尿,口服止血及抗感染药物等治疗效果不佳。尿常规、泌尿系彩超及CT等检查未见明显异常,行经尿道等离子双极电切镜、经尿道精囊镜双镜联合检查和治疗。结果手术均顺利完成,镜检显示13例均为尿道源性血精血尿,前列腺小囊及精囊未见异常,精阜周围及后尿道黏膜血管曲张,黏膜糜烂、渗血。均行经尿道等离子双极电切镜下黏膜电灼术,手术时间30~72 min,平均45 min。13例术后症状均消失,随访3~12个月,平均9个月,均未见复发。结论经尿道等离子双极电切镜、经尿道精囊镜双镜联合诊断和治疗尿道源性血精血尿安全,有效,微创。
Objective To investigate the clinical characteristics and treatment methods of urethral hemospermia and hematuria. Methods A retrospective analysis was made on 13 cases of hemospermia and hematuria from July 2015 to June 2017 in our hospital,aged 29-51 years old( average,37. 6 years old),with a history of 6 months-7 years( median,27 months). The manifestations were hemospermia and hematuria after sex,while oral hemostatic and anti-infection drugs had poor treatment effect and the symptoms were progressive and recurrent. The urine routine test,conventional ultrasound,and CT examination showed no significant abnormalities. The transurethral plasmakinetic cauterization of urethral mucosa combined with transurethral seminal vesiculoscopy was carried out. Results The procedure was completed smoothly in all the cases, which revealed urethral hemospermia and hematuria,no abnormalities in prostatic utricle and seminal vesicles,and the vascular engorgement,mucosa erosion and ooze blood around the seminal caruncle,and the posterior urethra mucosa. The operating time was 30-72 min( average,45 min). The symptoms of the 13 cases completely disappeared after operations. Follow-ups for 3-12 months( average,9 months) found no recurrence of symptoms. Conclusion Combination of transurethral plasma dipolar resectoscopy and seminal vesiculoscopy is safe,effective,and minimally invasive in diagnosis and treatment of urethral hemospermia and hematuria.
Objective To investigate the clinical characteristics and treatment methods of urethral hemospermia and hematuria. Methods A retrospective analysis was made on 13 cases of hemospermia and hematuria from July 2015 to June 2017 in our hospital,aged 29-51 years old( average,37. 6 years old),with a history of 6 months-7 years( median,27 months). The manifestations were hemospermia and hematuria after sex,while oral hemostatic and anti-infection drugs had poor treatment effect and the symptoms were progressive and recurrent. The urine routine test,conventional ultrasound,and CT examination showed no significant abnormalities. The transurethral plasmakinetic cauterization of urethral mucosa combined with transurethral seminal vesiculoscopy was carried out. Results The procedure was completed smoothly in all the cases, which revealed urethral hemospermia and hematuria,no abnormalities in prostatic utricle and seminal vesicles,and the vascular engorgement,mucosa erosion and ooze blood around the seminal caruncle,and the posterior urethra mucosa. The operating time was 30-72 min( average,45 min). The symptoms of the 13 cases completely disappeared after operations. Follow-ups for 3-12 months( average,9 months) found no recurrence of symptoms. Conclusion Combination of transurethral plasma dipolar resectoscopy and seminal vesiculoscopy is safe,effective,and minimally invasive in diagnosis and treatment of urethral hemospermia and hematuria.
引文
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2 白文俊,于志勇.射精与射精功能障碍.中国临床医生,2012,40(9):16-18.
3 De Sanctis V,Zargooshi J,Marsciani A,et al.For debate:should we worry about hematospermia in adolescents and young men?A report of six cases and review of the literature.Pediatr Endocrinol Rev,2017,14(3):281-288.
4 Hosseinzadeh K,Oto A,Allen BC,et al.ACR Appropriateness criteria hematospermia.J Am Coll Radiol,2017,14(5S):S154-S159.
5 廖良功,李彦锋.精道远端区域常见病变及精囊镜诊治技术的应用.中华医学杂志,2016,96(36):2849-2853.
6 赵军,翟小强,李和程,等.精囊镜治疗顽固性血精及射精管梗阻的经验初探.中华男科学杂志,2016,22(7):630-634.
7 安立哲,白文俊,许清泉,等.经前列腺小囊黏膜下隧道法精囊镜检查的可行性和疗效.中华泌尿外科杂志,2016,37(11):833-836.
8 肖恒军.精囊镜技术临床应用进展.现代泌尿外科杂志,2017,22(1):7-11.
9 Song Y,Zhao J,Dong Y,et al.Application of the ureteroscope for diagnosis and treatment of the seminal vesicle diseases.Int Surg,2015,100(7-8):1233-1236.
10 朱晓博,张祥生,张士龙,等.8.5/11.5F精囊镜在顽固性血精诊治中的应用.中华男科学杂志,2016,22(3):225-228.
11 张祥生,张士龙,闫天中,等.精囊镜技术在精道结石诊疗中的临床应用.临床泌尿外科杂志,2012,27(11):855-856,858.
12 李建伟,王芳,高宏志.经前列腺小囊射精管切开术治疗23例顽固性血精症临床分析.第三军医大学学报,2016,38(1):70-74.
13 陈岳兵,俞世成,何芊,等.经皮输精管置管辅助经自然腔道精囊镜手术.泌尿外科杂志(电子版),2016,8(3):53-55.
14 邵光峰,马天加,刘玉强,等.经直肠实时超声在精囊镜手术中的应用.中华男科学杂志,2017,23(4):337-342.
15 陈瑞廷,赵俊峰,梁魁,等.后尿道静脉曲张的诊断与治疗.山东医药,2012,52(42):60-61.
16 杨晓峰,米振国,刘尚莹,等.来源于尿道的血精和血尿51例报告.中华泌尿外科外科杂志,1995,16(5):45.
2 白文俊,于志勇.射精与射精功能障碍.中国临床医生,2012,40(9):16-18.
3 De Sanctis V,Zargooshi J,Marsciani A,et al.For debate:should we worry about hematospermia in adolescents and young men?A report of six cases and review of the literature.Pediatr Endocrinol Rev,2017,14(3):281-288.
4 Hosseinzadeh K,Oto A,Allen BC,et al.ACR Appropriateness criteria hematospermia.J Am Coll Radiol,2017,14(5S):S154-S159.
5 廖良功,李彦锋.精道远端区域常见病变及精囊镜诊治技术的应用.中华医学杂志,2016,96(36):2849-2853.
6 赵军,翟小强,李和程,等.精囊镜治疗顽固性血精及射精管梗阻的经验初探.中华男科学杂志,2016,22(7):630-634.
7 安立哲,白文俊,许清泉,等.经前列腺小囊黏膜下隧道法精囊镜检查的可行性和疗效.中华泌尿外科杂志,2016,37(11):833-836.
8 肖恒军.精囊镜技术临床应用进展.现代泌尿外科杂志,2017,22(1):7-11.
9 Song Y,Zhao J,Dong Y,et al.Application of the ureteroscope for diagnosis and treatment of the seminal vesicle diseases.Int Surg,2015,100(7-8):1233-1236.
10 朱晓博,张祥生,张士龙,等.8.5/11.5F精囊镜在顽固性血精诊治中的应用.中华男科学杂志,2016,22(3):225-228.
11 张祥生,张士龙,闫天中,等.精囊镜技术在精道结石诊疗中的临床应用.临床泌尿外科杂志,2012,27(11):855-856,858.
12 李建伟,王芳,高宏志.经前列腺小囊射精管切开术治疗23例顽固性血精症临床分析.第三军医大学学报,2016,38(1):70-74.
13 陈岳兵,俞世成,何芊,等.经皮输精管置管辅助经自然腔道精囊镜手术.泌尿外科杂志(电子版),2016,8(3):53-55.
14 邵光峰,马天加,刘玉强,等.经直肠实时超声在精囊镜手术中的应用.中华男科学杂志,2017,23(4):337-342.
15 陈瑞廷,赵俊峰,梁魁,等.后尿道静脉曲张的诊断与治疗.山东医药,2012,52(42):60-61.
16 杨晓峰,米振国,刘尚莹,等.来源于尿道的血精和血尿51例报告.中华泌尿外科外科杂志,1995,16(5):45.