一次性使用输精管介入治疗包临床应用初步研究
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摘要
目的:评估一种经皮穿刺输精管介入治疗包用于输精管造影的成功率以及安全性。方法:2016年10月至2017年4月采用开放、多中心、单组自身对照设计,纳入96例男性患者,年龄19~65岁,平均43岁,包括不育症、血精症、精囊囊肿、射精管囊肿、射精功能障碍、输精管损伤。患者均在局麻下应用穿刺包行输精管腔内注射造影剂并摄片。结果:完成试验的患者94例,造影成功者92例,成功率97.9%。造影结果显示,精道异常率为54.3%(51/94)。28例不育患者中,双侧输精管梗阻3例,单侧梗阻5例。44例血精患者中,36例(81.8%)为精囊炎。13例射精功能障碍患者中,5例(38.5%)双侧输精管发育异常。2例因行双侧腹股沟疝修补术致输精管损伤患者,精道造影均发现离断损伤至双侧输尿管。3例精囊囊肿和4例射精管囊肿通过输精管造影均明确诊断。结论:一次性使用输精管介入治疗包应用于输精管造影操作简单、安全性较高,值得推广应用。
Objective: To investigate the success rate and safety of percutaneous vasoseminal vesiculography with the disposable vasographic interventional therapy kit( VITK). Methods: This study included ninety-six 19-65( mean 43) years old male patients with infertility,hematospermia,seminal vesicle cyst,ejaculatory duct cyst,ejaculatory dysfunction,or vas deferens injury,with disease courses varying from 1 month to 7 years. With an open,multi-centered,single-group,self-controlled design and using the disposable VITK,we treated the patients by percutaneous vasoseminal vesiculography via injection of contrast medium into the vas deferens cavity under local anesthesia. Results: Percutaneous vasoseminal vesiculography was successfully performed in 92( 97. 87%) of the patients,which revealed abnormal seminal ducts in 51 cases( 54. 3%). Among the 28 infertile patients,3 were found with bilateral and 5 with unilateral vas deferens obstruction. Vesiculitis was detected in 36( 81. 8%) of the 44 hematospermia patients and bilateral vas deferens abnormality in 5( 38. 5%) of the 13 patients with ejaculatory dysfunction. Transectional damage was observed in 2 patients with vas deferens injury induced by bilateral inguinal hernia repair. Three cases of seminal vesicle cyst and 4 cases of ejaculatory cyst were definitely diagnosed by vasoseminal vesiculography. Conclusion: The disposable vasographic interventional therapy kit,with the advantages of simple operation and high safety,deserves a wide clinical application in vasoseminal vesiculography.
Objective: To investigate the success rate and safety of percutaneous vasoseminal vesiculography with the disposable vasographic interventional therapy kit( VITK). Methods: This study included ninety-six 19-65( mean 43) years old male patients with infertility,hematospermia,seminal vesicle cyst,ejaculatory duct cyst,ejaculatory dysfunction,or vas deferens injury,with disease courses varying from 1 month to 7 years. With an open,multi-centered,single-group,self-controlled design and using the disposable VITK,we treated the patients by percutaneous vasoseminal vesiculography via injection of contrast medium into the vas deferens cavity under local anesthesia. Results: Percutaneous vasoseminal vesiculography was successfully performed in 92( 97. 87%) of the patients,which revealed abnormal seminal ducts in 51 cases( 54. 3%). Among the 28 infertile patients,3 were found with bilateral and 5 with unilateral vas deferens obstruction. Vesiculitis was detected in 36( 81. 8%) of the 44 hematospermia patients and bilateral vas deferens abnormality in 5( 38. 5%) of the 13 patients with ejaculatory dysfunction. Transectional damage was observed in 2 patients with vas deferens injury induced by bilateral inguinal hernia repair. Three cases of seminal vesicle cyst and 4 cases of ejaculatory cyst were definitely diagnosed by vasoseminal vesiculography. Conclusion: The disposable vasographic interventional therapy kit,with the advantages of simple operation and high safety,deserves a wide clinical application in vasoseminal vesiculography.
引文
[1]Modgil V,Rai S,Ralph DJ,et al.An update on the diagnosis and management of ejaculatory duct obstruction.Nat Rev Urol,2016,13(1):13-20.
[2]吴宏飞,钱立新.精道造影术在精道疾病诊断中的应用.中华男科学杂志,2004,10(4):243-249.
[3]吴宏飞.射精管梗阻.中华男科学杂志,2010,16(1):3-9.
[4]孙冠浩,方丹波,朱选文,等.经皮输精管穿刺精道造影术的应用价值.中华男科学杂志,2004,10(8):614-615.
[5]田丽,郭燕,孟俊非.精道造影在男性不育症的应用及进展.国外医学:临床放射学分册,2006,29(1):64-65.
[6]谭仰明,尚克中,吴海林,等.精囊炎的介入诊断和治疗(附33例报告).实用放射学杂志,1997,13(3):135-137.
[7]Jones TR,Zagoria RJ,Jarow JP.Transrectal US-guided seminal vesiculography.Radiology,1997,205(1):276-278.
[8]Killi RM,Pourbagher A,Semerci B.Transrectal ultrasonography-guided echo-enhanced seminal vesiculography.BJU Int,1999,84(4):521-523.
[9]Engin G.Transrectal US-guided seminal vesicle aspiration in the diagnosis of partial ejaculatory duct obstruction.Diagn Interv Radiol,2012,18(5):488-495.
[10]李顺强,朱金波,王庆仁,等.经阴囊皮肤直接穿刺输精管造影术.中华泌尿外科杂志,1980,1(3):193-197.
[11]Weintraub MP,De Mouy E,Hellstrom WJ.Newer modalities in the diagnosis and treatment of ejaculatory duct obstruction.JUrol,1993,150(4):1150-1154.
[12]吴宏飞.经皮穿刺输精管精道造影术.中华男科学,2001,7(3):147-149.
[13]Matsumiya K,Namiki M,Takahara S,et al.Clinical study of azoospermia.Int J Androl,1994,17(3):140-142.
[14]Poore RE,Schneider A,De Franzo AJ,et al.Comparison of puncture versus vasotomy techniques for vasography in an animal model.J Urol,1997,158(2):464-466.
[2]吴宏飞,钱立新.精道造影术在精道疾病诊断中的应用.中华男科学杂志,2004,10(4):243-249.
[3]吴宏飞.射精管梗阻.中华男科学杂志,2010,16(1):3-9.
[4]孙冠浩,方丹波,朱选文,等.经皮输精管穿刺精道造影术的应用价值.中华男科学杂志,2004,10(8):614-615.
[5]田丽,郭燕,孟俊非.精道造影在男性不育症的应用及进展.国外医学:临床放射学分册,2006,29(1):64-65.
[6]谭仰明,尚克中,吴海林,等.精囊炎的介入诊断和治疗(附33例报告).实用放射学杂志,1997,13(3):135-137.
[7]Jones TR,Zagoria RJ,Jarow JP.Transrectal US-guided seminal vesiculography.Radiology,1997,205(1):276-278.
[8]Killi RM,Pourbagher A,Semerci B.Transrectal ultrasonography-guided echo-enhanced seminal vesiculography.BJU Int,1999,84(4):521-523.
[9]Engin G.Transrectal US-guided seminal vesicle aspiration in the diagnosis of partial ejaculatory duct obstruction.Diagn Interv Radiol,2012,18(5):488-495.
[10]李顺强,朱金波,王庆仁,等.经阴囊皮肤直接穿刺输精管造影术.中华泌尿外科杂志,1980,1(3):193-197.
[11]Weintraub MP,De Mouy E,Hellstrom WJ.Newer modalities in the diagnosis and treatment of ejaculatory duct obstruction.JUrol,1993,150(4):1150-1154.
[12]吴宏飞.经皮穿刺输精管精道造影术.中华男科学,2001,7(3):147-149.
[13]Matsumiya K,Namiki M,Takahara S,et al.Clinical study of azoospermia.Int J Androl,1994,17(3):140-142.
[14]Poore RE,Schneider A,De Franzo AJ,et al.Comparison of puncture versus vasotomy techniques for vasography in an animal model.J Urol,1997,158(2):464-466.