细针穿刺输精管造影对梗阻性无精子症的诊断作用  

The Diagnostic Effect of Opening Fine Needle Vasography on Obstructive Azoospermia

作　　者：赵良运[1] 胡美玉[2] 张志兴 刘晃 邓春华[4] 涂响安[1] 邓顺美 

机构地区：[1]中山大学第一附属医院黄埔院区泌尿外科,广东广州510700 [2]中山大学第一附属医院放射科,广东广州510700 [3]广东省计划生育科研所,广东广州510000 [4]中山大学第一附属医院泌尿外科,广东广州510080

出　　处：《湖北民族学院学报（医学版）》2011年第3期1-6,共6页Journal of Hubei Minzu University(Medical Edition)

基　　金：广东省人口和计划生育委员会科研基金资助项目(2009343)

摘　　要：目的探讨细针穿刺输精管造影对梗阻性无精子症梗阻部位的诊断和鉴别作用,分析其安全性和操作注意事项。方法对2005年7月至2009年7月收治的拟诊为"梗阻性无精子症"的患者57例行精液分析、经直肠超声检查(TRUS)及开放性细针穿刺输精管造影检查。结果 57例梗阻性无精子症的患者分别行精液分析、TRUS和开放性细针穿刺输精管造影检查,其中20例患者仅TRUS提示为射精管梗阻(EDO),造影证实其中3例(15%)实为EDO;17例患者仅精液分析提示为EDO,造影证实4例确实有EDO;20例患者TRUS和精液分析皆为EDO,但仅4例造影证实为EDO。所有患者中,双侧射精管梗阻仅6例(10.53%);双侧梗阻部位皆位于输精管和/或附睾者46例,其中双侧附睾部梗阻的患者最多(26例);另有一侧输精管梗阻、对侧射精管梗阻患者3例;一侧附睾部梗阻、对侧射精管部梗阻2例。并发症:仅1例出现阴囊血肿,保守治疗后吸收;轻度下腹胀痛3例,自行缓解。其中23例确诊附睾部梗阻的患者造影后4～6月返院行二期输精管、附睾吻合术中注水试验确认造影穿刺部位皆未形成新的梗阻。结论 TRUS和精液分析对国人射精管梗阻等梗阻性无精子症的诊断和鉴别诊断作用有限,细针穿刺输精管造影不仅能准确显示输精管道的梗阻部位、程度及原因,且其操作简便、安全,仍是国人射精管梗阻等梗阻性无精子症的诊断和鉴别诊断的金标准。术中精细操作、术后充分休息是其安全性的保障。Objective To evaluate the value of opening fine needle vasography in the diagnosis of the seminal duct system on the patients of obstructive azoospermia.And analyses its safety,complications and announcements on manipulation.Methods Between July 2005 and July 2009,fine needle vasography,TRUS and seminal fluid analysis were performed by turns on infertile male patients in our hospital,all were identified as obstructive azoospermia.Results Opening fine needle vasography,TRUS and seminal fluid analysis were performed by turns on57 infertile male patients in our hospital,all were identified as obstructive azoospermia.There were 20 patients diagnosed as EDO only by seminal fluid analysis,however only four of them were confirmed as EDO by vasography.And there were 17 patients diagnosed as EDO only by TRUS,however only three of them were confirmed as EDO by vasography.Between the 20 patients,who were diagnosed as EDO both by seminal fluid analysis and TRUS,there were only four patients confirmed as EDO by vasography.By opening fine needle vasography,6/57 patints（10.53%） were detected of bilateral ejaculatory duct obstruction.There were 46 patients showed the obstructive portions were located at bilateral vas deferens and/ or epididymis,and 26/47 patients were confirmed obstruction of bilateral epididymis.3/57 patients were visualized unilateral EDO and contralateral vas deferens obstruction,and 2 patientwere visualized unilateral ejaculatory duct obstruction and contralateral epididymis and the proximal vas deferens obstruction.The complications included 3 case of light gas pains in inferior belly which was relieved soon,and scrotal hematoma was found in one patient as a result of uncomplaisance and took action prematurely.Untill May 2011,vasoepididymostomy had been performed on 23 patients,who taken vasography,after 4 to 6 months rest.None of them were detected of obstruction or scar-hyperplasia inside the vas deferens lumen by affusion test in the operation.Conclusion The diagnostic and differential diagnostic eff

关 键 词：男性不育 梗阻性无精子症 输精管造影 经直肠超声检查 

分 类 号：R446.8[医药卫生—诊断学] R682[医药卫生—临床医学]