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目的:总结实施精囊镜手术采用的3种不同进镜途径,探讨经直肠实时超声引导下精囊镜手术的可靠性和有效性。方法:回顾性分析自2013年8月至2015年12月实施的精囊镜手术共90例,进镜途径为直接经射精管口、直接经前列腺小囊及经直肠实时超声引导下经前列腺小囊3种方式,进镜后对精囊疾病进行治疗,分别随访其治疗效果,比较3种进镜方式的成功率及并发症。结果:90例患者手术时间为25~75 min,平均时间42.3 min,手术的总成功率为96.67%(87/90)。直接经射精管口(包括异位开口)途径进入精囊30例,60例在正常解剖位置未找到射精管开口,采用经前列腺小囊途径进入精囊37例,上述途径均失败后,采用经直肠实时超声引导下进入精囊20例,3例患者精囊镜手术失败。92.06%(58/63)无精子症患者术中精囊液查见精子,77.78%(49/63)术后1周精液常规见精子。15例血精及12例精囊炎患者术后随访均治愈。术后随访20例患者出现水样精液,睾丸附睾炎3例,无逆行射精、尿失禁及直肠损伤等并发症。结论:经射精管口途径和经前列腺小囊途径为实施精囊镜手术的常规手术方法;而经直肠实时超声引导下经前列腺小囊途径能显著提高精囊镜检查成功率,避免术中对前列腺和直肠的损伤。
OBJECTIVE: To summarize the three different pathways used in seminal vesicle surgery to discuss the reliability and effectiveness of transrectal real-time ultrasound guided seminal vesicle surgery. Methods: A retrospective analysis of 90 cases of seminal vesicle surgery performed from August 2013 to December 2015 was performed directly through the ejaculatory duct and directly through the prostate vesicles and transrectal real-time ultrasound guided prostate vesicles Three ways, into the mirror after the treatment of seminal vesicle disease, respectively, follow-up of the treatment effect, compare the success rate of the three into the mirror and complications. Results: The operation time of 90 patients was 25-75 min with an average time of 42.3 min. The total success rate of operation was 96.67% (87/90). Directly through the ejaculatory orifice (including the ectopic opening) into the seminal vesicle in 30 cases, 60 cases in the normal anatomical location did not find the ejaculatory duct opening, the use of the prostate vesicular approach into the seminal vesicle in 37 cases, the above methods failed, the use of transrectal real-time Ultrasound guided into the seminal vesicle in 20 cases, 3 cases of seminal vesicle surgery failed. 92.06% (58/63) of patients with azoospermia seminal vesicle fluid check sperm, 77.78% (49/63) 1 week after surgery sperm routine sperm. 15 cases of blood serum and 12 cases of vesicular inflammation were followed up after surgery were cured. Twenty patients were followed up for 3 days with watery semen and testicular epididymitis without complications of retrograde ejaculation, incontinence and rectal injury. Conclusion: The ejaculatory vasodilatory pathway and the transplanted prostate capsule are the routine surgical methods for performing seminal vesicle surgery. Transrectal ultrasound guided transvaginal vesicle approach can significantly improve the success rate of seminal vesicle microscopy, Rectal injury.