Синдром Циннера: описание клинических случаев

ÂÑÅÐÎÑÑÈÉÑÊÈÉ ÌÅÆÄÈÑÖÈÏËÈÍÀÐÍÛÉ ÌÅÄÈÖÈÍÑÊÈÉ ÆÓÐÍÀË
© Êîëëåêòèâ àâòîðîâ, 2014
ÓÄÊ 616.6-008.6
À. Î. Âàñèëüåâ
À. Â. Ãîâîðîâ
êàíä. ìåä. íàóê
Þ. À. Êóïðèÿíîâ
Ê. Á. Êîëîíòàðёâ
êàíä. ìåä. íàóê
Ä. Þ. Ïóøêàðü
äîêò. ìåä. íàóê
Ìîñêîâñêèé ãîñóäàðñòâåííûé ìåäèêî-ñòîìàòîëîãè÷åñêèé óíèâåðñèòåò èì. À. È. Åâäîêèìîâà
Ñèíäðîì Öèííåðà:
îïèñàíèå êëèíè÷åñêèõ ñëó÷àåâ
Ñèíäðîì Öèííåðà – âðîæäåííîå ñîñòîÿíèå, õàðàêòåðèçóþùååñÿ íàëè÷èåì êèñòû ñåìåííîãî ïóçûðüêà â ñî÷åòàíèè ñ èïñèëàòåðàëüíîé àïëàçèåé ïî÷êè è îáñòðóêöèåé ñåìÿâûíîñÿùåãî ïðîòîêà. Ýòî ðåäêàÿ óðîëîãè÷åñêàÿ
àíîìàëèÿ ðàçâèòèÿ, ÷àùå âñåãî õàðàêòåðèçóþùàÿñÿ áåññèìïòîìíûì òå÷åíèåì è ïðèâîäÿùàÿ ê áåñïëîäèþ.  íåêîòîðûõ ñëó÷àÿõ ïàöèåíòîâ áåñïîêîÿò áîëè â ìîøîíêå è ïðîìåæíîñòè, áîëåçíåííîå ñåìÿèçâåðæåíèå, ãåìîñïåðìèÿ, äèçóðèÿ. Ó áîëüøèíñòâà ïàöèåíòîâ ñèíäðîì Öèííåðà âûÿâëÿåòñÿ â ïîëîâîçðåëîì âîçðàñòå ñëó÷àéíî ïðè
îáñëåäîâàíèè. Ñîâðåìåííûå ìåòîäû âèçóàëèçàöèè ñïîñîáñòâóþò ðàííåé äèàãíîñòèêå çàáîëåâàíèÿ è, êàê ñëåäñòâèå, ïðîôèëàêòèêå áåñïëîäèÿ. Ñèìïòîìàòè÷åñêàÿ òåðàïèÿ, à òàêæå äèíàìè÷åñêîå íàáëþäåíèå ïðè îòñóòñòâèè
êëèíè÷åñêèõ ïðîÿâëåíèé ÿâëÿþòñÿ ïðåäïî÷òèòåëüíûìè âàðèàíòàìè ëå÷åíèÿ. Ïðè îòñóòñòâèè ýôôåêòèâíîñòè
êîíñåðâàòèâíîé òåðàïèè ïàöèåíòó ïîêàçàíî õèðóðãè÷åñêîå ëå÷åíèå îòêðûòûì èëè ëàïàðîñêîïè÷åñêèì (ðîáîòàññèñòèðîâàííûì) äîñòóïîì. Ñâîåâðåìåííîå âûÿâëåíèå è ëå÷åíèå ñèíäðîìà Öèííåðà ïîçâîëÿåò óëó÷øèòü ïîêàçàòåëè ñïåðìîãðàììû, ÷òî äàåò âîçìîæíîñòü ïàöèåíòàì ðåàëèçîâàòü ðåïðîäóêòèâíóþ ôóíêöèþ.  äàííîé ñòàòüå
ìû îïèñûâàåì òðè ñëó÷àÿ âðîæäåííîé àíîìàëèè (êèñòû) ñåìåííûõ ïóçûðüêîâ ó ïàöèåíòîâ 20, 32 è 42 ëåò â
ñî÷åòàíèè ñ èïñèëàòåðàëüíîé àïëàçèåé ïî÷êè.
Êëþ÷åâûå ñëîâà: ñèíäðîì Öèííåðà, êèñòà ñåìåííîãî ïóçûðüêà, àïëàçèÿ ïî÷êè
Ñèíäðîì Öèííåðà ðàçâèâàåòñÿ âñëåäñòâèå ïàòîëîãèè ïðîòîêà ïåðâè÷íîé ïî÷êè (ìåçîíåôðîñà)
è âêëþ÷àåò îäíîñòîðîííþþ ïî÷å÷íóþ àïëàçèþ
(ïî íåêîòîðûì äàííûì — äèñïëàçèþ), êèñòó
ñåìåííîãî ïóçûðüêà íà ñòîðîíå îòñóòñòâèÿ ïî÷êè è îáñòðóêöèþ ñåìÿâûíîñÿùåãî ïðîòîêà [1].
Îáñòðóêöèÿ ñåìÿâûíîñÿùåãî ïðîòîêà ïðèâîäèò
ê ïîñòåïåííîìó íàêîïëåíèþ ñåêðåòà â ñåìåííûõ ïóçûðüêàõ è ïîñëåäóþùåìó îáðàçîâàíèþ
êèñòû. Çàáîëåâàíèå âïåðâûå îïèñàë A. Zinner
â 1914 ã. [2], äî íàñòîÿùåãî âðåìåíè â ëèòåðàòóðå îïèñàíî îêîëî ñòà ñëó÷àåâ çàáîëåâàíèÿ,
à ÷àñòîòà âñòðå÷àåìîñòè ñîñòàâëÿåò 0,00464 %
[3]. Â ïîñëåäóþùåì áûëà îïèñàíà óíèêàëüíàÿ
ïåíòàäà ïàòîëîãèè ìåçîíåôðîòè÷åñêîãî ïðîòîêà,
âêëþ÷àþùåé êèñòîçíóþ äèñïëàçèþ êàíàëüöåâîé ñåòè ÿè÷åê, êèñòó ñåìåííîãî ïóçûðüêà, èïñèëàòåðàëüíóþ àïëàçèþ ïî÷åê, äèëàòàöèþ ïðèäàòêà ÿè÷êà è ÷àñòè÷íîå ðàçâèòèå òðåóãîëüíèêà
ìî÷åâîãî ïóçûðÿ [4].
Àëåêñàíäð Îëåãîâè÷ Âàñèëüåâ
e-mail: alexvasilyev@me.com
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 äàííîé ñòàòüå ìû ðàññêàçûâàåì î ñîáñòâåííîì îïûòå äèàãíîñòèðîâàíèÿ è ëå÷åíèÿ òðåõ ïàöèåíòîâ ñ ñèíäðîìîì Öèííåðà.
Êëèíè÷åñêèé ïðèìåð № 1
Ïàöèåíò À., 32 ãîäà, îáðàòèëñÿ â êëèíèêó
óðîëîãèè ÌÃÌÑÓ ñ æàëîáàìè íà ãèïåðòåðìèþ
â âå÷åðíåå âðåìÿ äî 37,0–37,3° Ñ â òå÷åíèå
4 ìåñ äî íàñòîÿùåé ãîñïèòàëèçàöèè, çàòðóäíåííîå ìî÷åèñïóñêàíèå âÿëîé ñòðóåé, áîëè
â îáëàñòè ïðîìåæíîñòè, ýïèçîäû îñòðîé çàäåðæêè ìî÷è, ñàìîïðîèçâîëüíî ðàçðåøàâøèåñÿ.
Ïàöèåíò õîëîñò, äåòåé íå èìååò. Èç àíàìíåçà
èçâåñòíî, ÷òî â 16-ëåòíåì âîçðàñòå ïðè àìáóëàòîðíîì ÓÇÈ áûëà âûÿâëåíà åäèíñòâåííàÿ
ëåâàÿ ïî÷êà.  ïîñëåäóþùåì â äðóãîì ËÏÓ
ïðè ÓÇÈ âûÿâëåíî îáðàçîâàíèå ìî÷åâîãî ïóçûðÿ. Äî îáðàùåíèÿ â êëèíèêó óðîëîãèè ÌÃÌÑÓ
ïàöèåíò íåîäíîêðàòíî êîíñóëüòèðîâàëñÿ â ðàçëè÷íûõ ñïåöèàëèçèðîâàííûõ ìåäèöèíñêèõ ó÷ðåæäåíèÿõ Ìîñêâû, à òàêæå â óðîëîãè÷åñêîé
êëèíèêå Èçðàèëÿ: ðåêîìåíäîâàíî îïåðàòèâíîå
ëå÷åíèå â îáúåìå îòêðûòîé èëè ëàïàðîñêîïè÷åñêîé êèñòýêòîìèè. Îäíàêî â ñâÿçè ñ âîçìîæíûì ðàçâèòèåì ïîáî÷íûõ îñëîæíåíèé ïàöèåíò
îò îïåðàòèâíîãî ëå÷åíèÿ îòêàçàëñÿ. Äàëüíåéøåå
www.terramedica.spb.ru
TERRA MEDICA® № 2/ 2014
îáñëåäîâàíèå, âêëþ÷àâøåå ÒÐÓÇÈ è ÌÐÒ îðãàíîâ ìî÷åâûäåëèòåëüíîé ñèñòåìû, ïîäòâåðäèëî
îòñóòñòâèå ïðàâîé ïî÷êè è óìåðåííóþ ãèïåðòðîôèþ ëåâîé ïî÷êè, âûÿâèëî íàëè÷èå êèñòû
äèàìåòðîì 45 ìì â îáëàñòè ïðàâîãî ñåìåííîãî
ïóçûðüêà (ðèñ. 1).
Êëèíè÷åñêèé ïðèìåð № 2
Ïàöèåíò Â., 42 ãîäà, â òå÷åíèå äëèòåëüíîãî
âðåìÿ îòìå÷àë ïåðèîäè÷åñêóþ (ðàç â 4 ìåñ)
ïðèìåñü êðîâè â ñïåðìå, îäíîêðàòíóþ ïðèìåñü
êðîâè â ìî÷å, óìåðåííîå óõóäøåíèå êà÷åñòâà
ìî÷åèñïóñêàíèÿ. Ïàöèåíò æåíàò, äåòåé íå èìååò, â êà÷åñòâå êîíòðàöåïöèè ïðèìåíÿåò áàðüåðíûå ìåòîäû. Ïî ïîâîäó ïðèìåñè êðîâè â ñïåðìå
íå îáñëåäîâàëñÿ, ê âðà÷àì íå îáðàùàëñÿ, ñâÿçûâàÿ èìåþùååñÿ ñîñòîÿíèå ñ ôèçè÷åñêîé íàãðóçêîé. Èç àíàìíåçà èçâåñòíî, ÷òî â äåòñêîì
âîçðàñòå áûë ïîñòàâëåí äèàãíîç àïëàçèè ïðàâîé
ïî÷êè. Ïðè ïðîõîæäåíèè ïëàíîâîãî ìåäèöèíñêîãî îñìîòðà ïðè ÓÇÈ âûÿâëåíî îáðàçîâàíèå
â ìî÷åâîì ïóçûðå. Ó÷èòûâàÿ íàëè÷èå èìåâøåé
ìåñòî ïðèìåñè êðîâè â ìî÷å è ñïåðìå, âðà÷îìóðîëîãîì ðàéîííîé ïîëèêëèíèêè áûë ïîñòàâëåí
ïðåäâàðèòåëüíûé äèàãíîç îïóõîëè ìî÷åâîãî ïóçûðÿ. Ïàöèåíò êîíñóëüòèðîâàí â êëèíèêå óðîëîãèè ÌÃÌÑÓ. Ïðè òðàíñàáäîìèíàëüíîì ÓÇÈ
â ïîëîñòè ìî÷åâîãî ïóçûðÿ îïðåäåëÿëîñü îêðóãëîå îáðàçîâàíèå ñ ÷åòêèìè êîíòóðàìè, èìåþùåå æèäêîñòíûé êîìïîíåíò. Ïðè ÊÒ îðãàíîâ
ìî÷åâûäåëèòåëüíîé ñèñòåìû äèàãíîç àïëàçèè
Ðèñ. 1. ÌÐÒ ïàöèåíòà À., 32 ãîäà
Ïîäïèñíîé èíäåêñ 72075
ÓÐÎËÎÃÈß
ïðàâîé ïî÷êè áûë ïîäòâåðæäåí, â ïðîåêöèè
ïðàâîãî ñåìåííîãî ïóçûðüêà âûÿâëåíà êèñòà
äèàìåòðîì 25 ìì ñ ÷åòêèìè êîíòóðàìè, ñîäåðæàùàÿ æèäêîñòíûé êîìïîíåíò (ðèñ. 2).
Êëèíè÷åñêèé ïðèìåð № 3
Ïàöèåíò Ñ., 20 ëåò, ïðè ïîñòóïëåíèè â êëèíèêó óðîëîãèè ÌÃÌÑÓ ïðåäúÿâëÿë æàëîáû
íà ó÷àùåííîå ìî÷åèñïóñêàíèå, ïåðèîäè÷åñêóþ
áîëü â ìîøîíêå è ïðîìåæíîñòè, áîëåçíåííîå ñåìÿèçâåðæåíèå. Ïàöèåíò õîëîñò, äåòåé íå èìååò,
ïîëîâóþ æèçíü íå âåäåò. Èç àíàìíåçà èçâåñòíî,
÷òî âûøåîïèñàííûå æàëîáû áåñïîêîÿò íà ïðîòÿæåíèè ãîäà. Ïðè àìáóëàòîðíî âûïîëíåííîé
ÌÑÊÒ îðãàíîâ ìî÷åâûäåëèòåëüíîé ñèñòåìû âûÿâëåíà àïëàçèÿ ëåâîé ïî÷êè, ïî äàííûì ÓÇÈ â
ïðîåêöèè ëåâîãî ñåìåííîãî ïóçûðüêà âûÿâëåíà
êèñòà îáúåìîì îêîëî 20 ñì3, ïðè ýêñêðåòîðíîé
óðîãðàôèè â ïðîåêöèè ìî÷åâîãî ïóçûðÿ îòìå÷àëñÿ äåôåêò íàïîëíåíèÿ, ×ËÑ ïðàâîé ïî÷êè
êîíòðàñòèðîâàíà (ðèñ. 3).
Ñ áîëüíûìè ïðîâåäåíà áåñåäà îòíîñèòåëüíî
èìåþùåãîñÿ çàáîëåâàíèÿ è ñóùåñòâóþùèõ ìåòîäîâ ëå÷åíèÿ. Ïàöèåíòû íàñòàèâàëè íà êîíñåðâàòèâíîì ëå÷åíèè. Ó÷èòûâàÿ óìåðåííî âûðàæåííûå êëèíè÷åñêèå ïðîÿâëåíèÿ, à òàêæå
îòñóòñòâèå êàêèõ-ëèáî èçìåíåíèé ñî ñòîðîíû
ëàáîðàòîðíûõ àíàëèçîâ (âêëþ÷àÿ ãîðìîíàëüíûé) è ñïåðìîãðàììû, ïðèíÿòî ðåøåíèå âûïîëíèòü ïóíêöèþ êèñò ñåìåííûõ ïóçûðüêîâ
ïîä ìåñòíîé àíåñòåçèåé ïîä êîíòðîëåì ÒÐÓÇÈ.
Ðèñ. 2. ÊÒ ïàöèåíòà Â., 42 ãîäà; ñòðåëêîé óêàçàíà
êèñòà ñåìåííîãî ïóçûðüêà, ïðîëàáèðóþùàÿ
â ïîëîñòü ìî÷åâîãî ïóçûðÿ
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ÂÑÅÐÎÑÑÈÉÑÊÈÉ ÌÅÆÄÈÑÖÈÏËÈÍÀÐÍÛÉ ÌÅÄÈÖÈÍÑÊÈÉ ÆÓÐÍÀË
Ðèñ. 3. Ýêñêðåòîðíàÿ óðîãðàôèÿ ïàöèåíòà Ñ., 20 ëåò
 õîäå ìàíèïóëÿöèè ó ïàöèåíòîâ À., Â. è Ñ.
ïîëó÷åíî ïî 30, 25 è 15 ìë æèäêîñòè «øîêîëàäíîãî» öâåòà, ñîîòâåòñòâåííî.  êàæäîì ñëó÷àå àñïèðèðîâàííàÿ æèäêîñòü áûëà îòïðàâëåíà
íà áàêòåðèîëîãè÷åñêèé ïîñåâ è öèòîëîãè÷åñêîå
èññëåäîâàíèå, ïî äàííûì êîòîðûõ ðîñòà ìèêðîôëîðû è àòèïè÷åñêèõ êëåòîê íå âûÿâëåíî. Íà
ñëåäóþùèé äåíü ïîñëå ïóíêöèè êèñòû ïàöèåíòû îòìåòèëè óëó÷øåíèå îáùåãî ñîñòîÿíèÿ,
óìåíüøåíèå áîëåâîé ñèìïòîìàòèêè â îáëàñòè
ïðîìåæíîñòè. Ñïóñòÿ ãîä ïàöèåíò À. ïåðåíåñ
ïîâòîðíóþ ïóíêöèþ êèñòû ñåìåííîãî ïóçûðüêà.
Îáúåì æèäêîñòè ïðè ïîâòîðíîé ïóíêöèè ñîñòàâèë 20 ìë.
Íà ñåãîäíÿøíèé ìîìåíò ïàöèåíòû ïðîäîëæàþò íàáëþäàòüñÿ.  õîäå äèíàìè÷åñêîãî íàáëþäåíèÿ, ïðè ÒÐÓÇÈ îòìå÷åíà òåíäåíöèÿ ê ïîñòåïåííîìó ñíèæåíèþ îáúåìà êèñòû.
Ñèíäðîì Öèííåðà, êàê ïðàâèëî, äèàãíîñòèðóåòñÿ â 3-é èëè 4-é äåêàäå æèçíè è ÷àñòî ñîïðîâîæäàåòñÿ áåñïëîäèåì [5]. Êèñòà ñåìåííîãî ïóçûðüêà ìîæåò áûòü èçíà÷àëüíî âðîæäåííîé èëè
ðàçâèâàòüñÿ ïîñòåïåííî âñëåäñòâèå îáñòðóêöèè
ñåìÿâûíîñÿùèõ ïðîòîêîâ, ïðîòåêàÿ áåññèìïòîìíî èëè ñ íåçíà÷èòåëüíûìè êëèíè÷åñêèìè ïðîÿâëåíèÿìè (áîëü â ïðîìåæíîñòè è/èëè äèçóðèÿ) [6]. Êèñòà ñåìåííîãî ïóçûðüêà ìîæåò áûòü
äîñòàòî÷íî áîëüøîé ïî ðàçìåðó è âäàâàòüñÿ â
ïðîñâåò ìî÷åâîãî ïóçûðÿ, ÷òî ïîçâîëÿåò âûÿâèòü
åå ïðè ÓÇÈ. Îáñòðóêöèÿ íà óðîâíå ñåìÿâûíîñÿùèõ ïðîòîêîâ ÿâëÿåòñÿ ñàìîé ÷àñòîé ïðè÷èíîé
ïðèîáðåòåííîé îáñòðóêòèâíîé àçîîñïåðìèè [7],
÷òî, â èòîãå, ìîæåò ïðèâîäèòü ê áåñïëîäèþ.
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Äàííûé ôàêò ïîä÷åðêèâàåò íåîáõîäèìîñòü
äåòàëüíîãî îáñëåäîâàíèÿ áîëüíûõ ñ ïîäîçðåíèåì íà ñèíäðîì Öèííåðà è ïðîâåäåíèå äèôôåðåíöèàëüíîãî äèàãíîçà ñ «ïîõîæèìè» çàáîëåâàíèÿìè. Áîëüíûì îáÿçàòåëüíî ïðîâîäÿò ÓÇÈ
ìîøîíêè, êîòîðîå ïîìîãàåò âûÿâèòü ïðèçíàêè
îáñòðóêöèè (ðàñøèðåíèå ñåòè ÿè÷êà, óâåëè÷åíèå ïðèäàòêà ÿè÷êà ñ êèñòîçíûìè èçìåíåíèÿìè èëè îòñóòñòâèå ñåìÿâûíîñÿùåãî ïðîòîêà).
Äëÿ ïàöèåíòîâ ñ ìàëåíüêèì îáúåìîì ýÿêóëÿòà
(<1,5 ìë) è ïîäîçðåíèåì íà îáñòðóêöèþ ïðîòîêà ïîêàçàíî âûïîëíåíèå ÒÐÓÇÈ â äâóõ ïðîåêöèÿõ. ÒÐÓÇÈ ìîæåò áûòü òàêæå èñïîëüçîâàíî
äëÿ àñïèðàöèè ñîäåðæèìîãî ñåìåííûõ ïóçûðüêîâ [8].
Ïî ìíåíèþ áîëüøèíñòâà àâòîðîâ, êîíñåðâàòèâíàÿ ñèìïòîìàòè÷åñêàÿ òåðàïèÿ, à òàêæå
äèíàìè÷åñêîå íàáëþäåíèå ÿâëÿþòñÿ ïðåäïî÷òèòåëüíûìè âàðèàíòàìè ïðè îòñóòñòâèè êëèíè÷åñêèõ ïðîÿâëåíèé çàáîëåâàíèÿ.  ñëó÷àå
íåýôôåêòèâíîñòè êîíñåðâàòèâíûõ ìåòîäîâ
ëå÷åíèÿ íàèáîëåå îïðàâäàííîé ÿâëÿåòñÿ õèðóðãè÷åñêàÿ òàêòèêà, â òîì ÷èñëå ñ ïðèìåíåíèåì ðîáîò-àññèñòåíöèè [9]. Íåêîòîðûå àâòîðû
ñêëîíÿþòñÿ ê âûïîëíåíèþ òðàíñóðåòðàëüíîé
ðåçåêöèè âûõîäíûõ îòäåëîâ ñåìÿâûáðàñûâàþùèõ ïðîòîêîâ â çîíå ñåìåííîãî áóãîðêà — îïåðàöèè TURED (transurethral resection of the
ejaculatory ducts) [10], ïîä÷åðêèâàÿ, ÷òî â ñëó÷àÿõ ôóíêöèîíàëüíîé îáñòðóêöèè äèñòàëüíûõ
îòäåëîâ ñåìÿâûáðàñûâàþùèõ ïðîòîêîâ îïåðàöèÿ óëó÷øàåò ïîêàçàòåëè ñïåðìîãðàììû è âûáðîñ ýÿêóëÿòà, ÷òî ìîæåò ïîëîæèòåëüíî ñêàçàòüñÿ íà ðåïðîäóêòèâíîé ôóíêöèè [11].
Ñîãëàñíî Guidelines EAU 2013 ã., àëüòåðíàòèâîé îïåðàöèè TURED ñëóæàò ìèêðîõèðóðãè÷åñêîå âûäåëåíèå ñïåðìàòîçîèäîâ èç ïðèäàòêà ÿè÷êà — îïåðàöèÿ MESA (microsurgical
epididymal sperm aspiration), âûäåëåíèå ñïåðìàòîçîèäîâ èç òêàíè ÿè÷êà — îïåðàöèÿ TESE
(testicular sperm extraction), àñïèðàöèÿ ñïåðìàòîçîèäîâ èç ïðîêñèìàëüíîé ÷àñòè ñåìÿâûíîñÿùåãî ïðîòîêà, èç ñåìåííûõ ïóçûðüêîâ ïîä
êîíòðîëåì ÓÇÈ è ïðÿìàÿ àñïèðàöèÿ ñåìåííîé
æèäêîñòè èç êèñòû [12].
Ñèíäðîì Öèííåðà — çàáîëåâàíèå, êîòîðîå
íåîáõîäèìî ïîäîçðåâàòü ó ïàöèåíòîâ ìóæñêîãî
ïîëà ñ àïëàçèåé ïî÷êè è äèàãíîñòèðîâàííûì îáðàçîâàíèåì â îáëàñòè ïðîåêöèè ìî÷åâîãî ïóçûðÿ.
 áîëüøèíñòâå ñëó÷àåâ ñèìïòîìàìè çàáîëåâàíèÿ ÿâëÿþòñÿ ãåìàòóðèÿ, ãåìîñïåðìèÿ, ãèïîñïåðìèÿ, íàðóøåíèå ýÿêóëÿöèè, à òàêæå äèñêîìôîðò
â ïðîìåæíîñòè ïîñëå ýÿêóëÿöèè. Ñîâðåìåííûå
ìåòîäû âèçóàëèçàöèè, òàêèå êàê ÌÐÒ, ÊÒ è
www.terramedica.spb.ru
ÓÐÎËÎÃÈß
TERRA MEDICA® № 2/ 2014
ÒÐÓÇÈ, ñïîñîáñòâóþò ðàííåé äèàãíîñòèêå ñèíäðîìà Öèííåðà. Íà÷èíàòü ëå÷åíèå öåëåñîîáðàçíî ñ êîíñåðâàòèâíîé òàêòèêè, îäíàêî òîëüêî
õèðóðãè÷åñêîå ëå÷åíèå ÿâëÿåòñÿ åäèíñòâåííîé
òàêòèêîé äëÿ èçáàâëåíèÿ ïàöèåíòà îò èìåþùèõñÿ æàëîá è ïðîôèëàêòèêè áåñïëîäèÿ. Ïðè îòñóòñòâèè êàêèõ-ëèáî æàëîá ñî ñòîðîíû îðãàíîâ
ìî÷åâûäåëèòåëüíîé ñèñòåìû ïàöèåíòàì ïðåäïî÷òèòåëüíî íàçíà÷àòü ñèìïòîìàòè÷åñêóþ òåðàïèþ.
 íàñòîÿùåå âðåìÿ ëàïàðîñêîïè÷åñêàÿ è ðîáîòàññèñòèðîâàííàÿ ìåòîäèêè ïîñòåïåííî çàìåíÿþò
îòêðûòûå õèðóðãè÷åñêèå âìåøàòåëüñòâà.
 íàøåì èññëåäîâàíèè ïðåäñòàâëåíû ñîáñòâåííûå ðåçóëüòàòû äèàãíîñòèêè è ëå÷åíèÿ ïàöèåíòîâ ñ ñèíäðîìîì Öèííåðà. Ó÷èòûâàÿ ìèíèìàëüíûå êëèíè÷åñêèå ïðîÿâëåíèÿ çàáîëåâàíèÿ,
ïðèíÿòî ðåøåíèå î ñèìïòîìàòè÷åñêîé òåðàïèè è
äèíàìè÷åñêîì íàáëþäåíèè çà ïàöèåíòàìè.
Ëèòåðàòóðà
1. Parsons R. B., Fisher A. M., Bar-Chama N. et al. MR
Imaging in male infertility // Radiographics. 1997. Vol. 17.
P. 627–637.
2. Zinner A. Ein fall von intravesikaler Samenblasenzyste //
Wien. med. Wschr. 1914. Bd. 64. S. 605–609.
3. Sheih C. P., Hung C. S., Wei C. F. Cystic dilatations
within the pelvis in patients with ipsilateral renal agenesis
or dysplasia // J. Urol. 1990. Vol. 144. P. 324–327.
4. Casey R. G., Stunell H., Buckley O. A unique radiological
pentad of mesonephric duct abnormalities in a young man
presenting with testicular swelling // J. Radiol. 2008.
Vol. 81. P. 93–96.
5. Livingston L., Larson C. R. Seminal vesicle cyst with
ipsilateral renal agenesis // AJR. Amer. J. Roentgenol.
2000. Vol. 175. P. 177–180.
6. Cihan A., Cimen S., Secil M. Congenital seminal vesicle cyst accompanying ipsilateral renal agenesis and
rudimentary ureter // Int. Urol. Nephrol. 2006. Vol. 38.
P. 133–135.
7. McVicar C. M., O´Neill D. A., McClure N. Effects of
vasectomy on spermatogenesis and fertility outcome after
testicular sperm extraction combined with ICSI // Hum.
Reprod. 2005. Vol. 20(10). P. 2795–2800.
8. Jarow J. P. Seminal vesicle aspiration of fertile men //
J. Urol. 1996. Vol. 156(3). P. 1005–1007.
9. Altobelli E., Bove A. M., Falavolti C. Robotic-assisted
laparoscopic approach in the treatment for Zinner’s
Syndrome associated with ipsilateral megaureter and
in-complete double-crossed ectopic ureter // Int. Urol.
Nephrol. 2013. Vol. 45(3). P. 635–638.
10. Pace G., Galatioto G. P., Gualà L. Ejaculatory duct
obstruction caused by a right giant seminal vesicle with
an ipsilateral upper urinary tract agenesia: an embryologic
malformation // Fertil. and Steril. 2008. Vol. 89(2).
P. 390–394.
11. Fisch H., Lambert S. M., Goluboff E. T. Management
of ejaculatory duct obstruction: etiology, diagnosis, and
treatment // Wld J. Urol. 2006. Vol. 24(6). P. 604–610.
12. Jungwirth A., Diemer T., Dohle G. R. et al. EAU Guidelines on Male Infertility, 2013. P. 24–28.
A. O. Vasilyev, A. V. Govorov, K. B. Kolontarev, U. A. Kupriyanov, D. U. Pushkar
Moscow State University of Medicine and Dentistry named after A. I. Evdokimov
Zinner´s syndrome: description of the clinical cases
Zinner’s syndrome — a congenital condition characterized by the presence of seminal vesicle cysts in combined with ipsilateral
renal aplasia and obstruction of the vas deferens. This is a rare urological anomaly of development often characterized by asymptomatic and leads to infertility. In some cases, patients concerned pain in the scrotum and perineum, painful ejaculation, gemospermiya, dysuria. Most patients Zinner’s syndrome detected in puberty by random findings in the survey. Modern imaging techniques
contribute to the early diagnosis of disease and prevention of infertility. Symptomatic therapy, and dynamic monitoring in the
absence of clinical manifestations are the preferred treatment options. In the absence of the effectiveness of conservative therapy
the surgical treatment by open or laparoscopic (robot-assisted) access is recommended. Early detection and treatment of the
Zinner’s syndrome improves the semen that enables patients to implement reproductive function. In this paper, we describe 3 cases
of congenital anomalies (cysts) of the seminal vesicles in patients 20, 32 and 42 years in combined with ipsilateral renal aplasia.
Key words: Zinner´s syndrome, seminal vesicle cyst, aplasia of the kidney
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