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目的:探讨精道结石形成原因及精囊镜技术在治疗精道结石中的临床应用。方法:22例精道结石合并血精患者术前经彩超、CT及X线平片检查,诊断前列腺结石10例,前列腺钙化3例,精囊结石9例。均先采用精囊镜观察精阜前列腺小囊开口方向,然后在超滑镍钛导丝引导下将精囊镜插入前列腺小囊及精囊进行检查、取石、钬激光碎石或前列腺囊肿开窗冲洗治疗。结果:精囊镜检查发现精阜前列腺小囊开口朝向尿道内口方向6例,垂直尿道11例,尿道外口方向5例。18例精道结石经过冲洗或用异物钳取出,2例经钬激光碎石后取出结石,2例前列腺囊肿行尿道侧囊肿开窗冲洗并取结石。随访(4.9±1.8)个月,血精、疼痛症状均完全消失;结石残留4例,无自觉不适。结石成分分析:磷酸钙结石5例,碳酸钙结石8例,尿酸结石4例,混合性结石5例。结论:精道结石发生可能与精阜前列腺小囊开口方向变异或狭窄有关。经尿道精囊镜下取石是治疗精道结石的有效方法,具有创伤小、并发症少、疗效好、恢复快的优点。
Objective: To investigate the causes of fine stone and the clinical application of seminal vesicle mirror technique in the treatment of fine stone. Methods: Twenty-two cases of pathological stones combined with semen were examined by color Doppler ultrasonography, computed tomography and X-ray. 10 cases of prostate calculi, 3 cases of prostatic calcification and 9 cases of seminal vesicle stones were diagnosed. Seminal vesicles were first used to observe the direction of fine Fu prostate capsule opening, and then under the guidance of ultra-smooth nickel titanium guide capillaries into the seminal vesicles and seminal vesicle examination, lithotripsy, holmium laser lithotripsy or prostate cyst opening window treatment. Results: Seminal vesicle examination found that fine Fu prostate capsule opening toward the direction of the urethra in 6 cases, 11 cases of vertical urethra, urethral orifice direction in 5 cases. Eighteen cases of pathological stones were rinsed or removed with foreign body forceps. Two cases of stones were removed after holmium laser lithotripsy. Two cases of prostatic cyst underwent urethral cyst washing and calcification. Follow-up (4.9 ± 1.8) months, blood serum, pain symptoms were completely disappeared; residual stones in 4 cases, no conscious discomfort. Analysis of stone composition: calcium phosphate stones in 5 cases, calcium carbonate stones in 8 cases, uric acid stones in 4 cases, mixed stones in 5 cases. Conclusion: The pathological changes of fine stones may be related to the variation or stenosis of the fine vesicles in the opening of fine prostate. Transurethral seminal vesicle under the microscope is an effective method for the treatment of fine stones, with less trauma, fewer complications, good efficacy and quick recovery.