经直肠实时超声引导精囊镜在治疗射精管梗阻性无精子症的效果分析

目的:探讨经直肠实时超声引导精囊镜(TRUS-SVS)治疗射精管梗阻性无精症的可行性和有效性。方法:回顾2016年6月至2018年6月我院术前确诊为双侧射精管梗阻性无精子症且经射精管开口和前列腺小囊进入精囊均失败40例患者临床资料,采用TRUS-SVS进入精囊,分析手术进镜成功率、手术时间、并发症和治疗效果,评估TRUS-SVS的应用价值。结果:采用TRUS-SVS成功进入精囊36例,手术进镜成功率达90.0%(36/40),其中双侧精囊镜检查33例,单侧精囊镜检查3例,平均手术时间(32.8±16.6)min,37例获得随访,随访时间6~15个月,平均9.3个月,术后1~3个月查精液找到精子31例,4~12个月查精液找到精子25例,术后12月内配偶妊娠9例。术后附睾炎2例,血尿2例,后随访均治愈,所有患者均无逆行射精、尿失禁及直肠损伤等严重并发症。结论:对于经射精管开口和经前列腺小囊进入精囊均失败的患者,TRUS-SVS进镜可增加手术进镜成功率,提高手术的安全性,减少术中对前列腺和直肠的损伤,改善患者的精液质量,可作为常规手术路径失败一种新的选择。

Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of azoospermia secondary to ejaculatory duct obstruction

Objective:To evaluate the effect of real-time transrectal ultrasound-guided seminal vesiculoscopy(TRUS-SVS)in the treatment of azoospermia secondary to ejaculatory duct obstruction.Methods:This retrospective study included 40 cases of azoospermia secondary to bilateral ejaculatory ducts obstruction treated by TRUS-SVS from June 2016 to June 2018 after failure to enter the vesiculoscope through the ejaculatory duct or prostatic utricle.We analyzed the success rate of surgery,operation time,postoperative complications,treatment results,and application value of TRUS-SVS.Results:Real-time TRUS-SVS was successfully performed in 36(90.0%)of the cases,33 through bilateral and the other 3 through unilateral seminal vesicle,with a mean operation time of(32.8±16.6)min.Thirty-seven of the cases were followed up for 6-15(mean 9.3)months,of which sperm were found in 31 at 1-3 months and in 25 at 3-12 months,and pregnancies achieved in 9 cases within 12 months after surgery.No serious complications as retrograde ejaculation,urinary incontinence and rectal injury were observed postoperatively,except 2 cases of epididymitis and 2 cases of hematuria,which were all cured.Conclusion:For the patients who failed in seminal vesiculoscopy through the ejaculatory duct or prostatic utricle,real-time TRUS-SVS is a recommended procedure with the advantages of a high success rate,less damage to the prostate and rectum,and benefit to the improvement of semen quality.