【摘要】 目的 观察精囊磁共振成像(MRI)定位联合F4.8可视穿刺超微肾镜治疗精囊疾病的临床疗效。方法 回顾性分析2021年1月至2023年3月南方医科大学第七附属医院泌尿外科收治的17例血精患者的临床资料。患者术前均行精囊MRI,采用F4.8可视穿刺超微肾镜行精囊腔检查及手术治疗。记录手术前后精液相关指标变化情况、症状改善情况以及并发症发生情况。结果 17例患者均顺利完成手术，手术时间43～57(48.65±4.94)min。术中发现前列腺小囊内结石3例，精囊结石8例，精囊囊肿1例，射精管囊肿2例，精囊息肉1例，精囊炎2例。术中无直肠损伤、尿道外括约肌损伤、周围脏器损伤等并发症发生。术后3个月复查均无肉眼血精，下腹部坠胀痛、射精疼痛等症状的改善率达94.12%(16/17)。复查精液相关指标(精液量、精液pH、精子浓度、精子总活力、精浆果糖、红细胞、白细胞)均较术前显著改善。术后无逆行射精、尿失禁、排尿不畅、性功能减退、附睾炎等并发症。结论 采用精囊MRI定位联合F4.8可视穿刺超微肾镜治疗精囊疾病具有创伤小、并发症少、临床疗效好等优点，值得在临床推广应用。更多还原

【Abstract】 Objective To observe the clinical efficacy of magnetic resonance imaging(MRI) localization of seminal vesicle combined with F4.8 visual puncture super-mini nephroscope in treating seminal vesicle diseases.Methods The clinical data of 17 patients with hematospermia who were admitted to Department of Urology, the Seventh Affiliated Hospital of Southern Medical University from January 2021 to March 2023 were retrospectively analyzed. MRI was performed on the seminal vesicles of all the patients before operation, and the seminal vesicle lumen was examined and surgically treated with F4.8 visual puncture super-mini nephroscope. The changes in semen-related indicators before and after surgery, and the sympton improvement and the occurrence of complications after surgery were recorded.Results The operations of all the 17 patients were successfully completed, and the duration of surgery was 43-57(48.65±4.94)minutes. The intraoperative findings indicated that there were 3 cases of prostatic utricle calculi, 8 cases of seminal vesicle calculi, 1 case of seminal vesicle cysts, 2 cases of ejaculatory duct cysts, 1 case of seminal vesicle polyps and 2 cases of seminal vesiculitis. There were no complications such as rectal injury, external urethral sphincter injury and peripheral organ injury during the operation. The patients were reexamined 3 months after surgery, and all the patients had no gross hematospermia, and the improvement rate of the symptoms such as lower abdominal distending pain and ejaculation pain was 94.12%(16/17). After reexamination, the postoperative semen-related indicators(semen volume, semen pH value, sperm concentration, total sperm motility, seminal plasma fructose, red blood cells and white blood cells) were significantly improved compared with the preoperative semen-related indicators. After surgery, there were no complications such as retrograde ejaculation, urinary incontinence, urinary stammering, decrements in sexual function and epididymitis.Conclusion The treatment of seminal vesicle diseases with MRI localization of seminal vesicle combined with F4.8 visual puncture super-mini nephroscope has the advantages of less trauma, fewer complications and good clinical effect, and is worthy of clinical promotion and application.更多还原