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目的:对输尿管镜下钬激光内切开与单纯输尿管镜精道检查治疗远端精道疾病疗效进行对比分析。方法:回顾分析2003年12月~2012年8月远端精道疾病患者71例,血精57例,单纯射精管囊肿8例,无精症6例。均行精液分析、经直肠前列腺、精囊彩超检查,部分患者行盆腔CT或MRI检查。结果:54例血精患者(3例未进入),24例行单纯输尿管镜精道检查,30例行输尿管镜下钬激光内切开。均有不同程度的射精管开口狭窄或梗阻;7例单纯射精管口囊肿,行钬激光囊肿去顶减压术。6例无精症患者均表现为射精管开口梗阻,伴精囊扩张,行钬激光内切开术。术后随访,行单纯输尿管镜精道检查患者中,1例术后6个月、1例术后8个月血精复发,再次手术,发现射精管开口狭窄,行钬激光内切开术,术后血精消失。7例有前列腺炎的单纯射精管口囊肿患者,术后3个月复查,3例治愈,3例好转,1例无效。6例无精症患者,2例患者配偶分别于术后7、14个月妊娠,4例术后1~3个月内即可查及精子,1例患者术后随访12个月未发现精子。3例术后出现附睾炎,经抗感染、对症治疗,好转。未发生逆行射精、尿失禁或直肠损伤等并发症。结论:输尿管镜钬激光内切开较单纯输尿管镜精道检查治疗远端精道疾病疗效更好,是否值得临床推广应用,还需进一步观察总结。
OBJECTIVE: To compare and analyze the curative effect of ureteroscopic holmium laser endotracheal examination and simple ureteroscopic fine tract examination for treatment of distal stenosis disease. Methods: Retrospective analysis from December 2003 to August 2012 in 71 cases of distal spermatic disease, 57 cases of semen, 8 cases of simple ejaculatory cysts, 6 cases of azoospermia. Underwent semen analysis, transrectal prostate, seminal vesicle ultrasound examination, some patients underwent pelvic CT or MRI examination. Results: Fifty-four patients (3 patients did not enter the blood serum), 24 patients underwent simple ureteroscope examination, and 30 underwent ureteroscopic holmium laser incision. There are different degrees of ejaculation stenosis or obstruction; 7 cases of ejaculatory duct cysts, holmium laser cyst decompression surgery. 6 patients with azoospermia showed ejaculatory duct obstruction, with seminal vesicle expansion, holmium laser endotomy. Postoperative follow-up, plain ureteroscopy in patients with fine, 1 case 6 months after surgery, 1 case 8 months after blood serum relapse, reoperation and found that the ejaculatory duct stenosis, holmium laser endotomy, Postoperative blood fine disappears. 7 cases of prostatitis patients with simple eustachian tube cysts, 3 months after the review, 3 cases were cured, 3 cases improved, 1 case ineffective. Six patients with azoospermia, two patients with spouses were pregnant at 7 and 14 months postoperatively, 4 cases were able to detect sperm within 1 to 3 months after operation, and one patient was found sperm after 12 months of follow-up . 3 cases of postoperative epididymitis, anti-infective, symptomatic treatment, improved. No retrograde ejaculation, urinary incontinence or rectal injury and other complications. Conclusion: Endoscopic ureteroscopic holmium laser is more effective than simple ureteroscopy in the treatment of distal stenosis. It is worth further clinical application.