附睾输精管吻合术后男性生育力的临床评估  

The clinical evaluation of male fertility after the epididymovasostomy

作　　者：刘晃[1] 唐立新[1] 汤乐[1] 刘兴章[1] 郑厚斌[1] 张志兴[1] 王奇玲[1] 

机构地区：[1]广东省计划生育科学技术研究所,广州510600

出　　处：《山西医科大学学报》2014年第3期220-223,共4页Journal of Shanxi Medical University

基　　金：广东省科技基金资助项目(2011B031900001)

摘　　要：目的 临床评估显微附睾输精管吻合术后男性患者的生育力.方法 回顾性分析2005-01～2011-12间在我院行内2-外4针法附睾输精管显微吻合术的120例附睾梗阻性无精子症患者的临床资料以及术后随访2年的结果,观察术后患者精子质量恢复情况以及其配偶受孕状况.结果 120例附睾梗阻性无精子症患者采用内2-外4针法附睾输精管吻合术,手术历时（52.83±7.28） min.术后随访2年,在射出精液中检出精子67例,占55.83％,其中术后1个月内检出精子18例,3个月后检出精子35例,半年后检出精子14例;术后精液参数为：精子浓度均值14.11×106/ml（95％ CI：12.54×106-17.73 ×106）;前向运动精子百分率30.89％（95％ CI：28.42％-33.04％）;正常形态精子百分率5.21％（95％CI：4.55％-6.52％）,与WHO精液分析手册（2010版）正常人群精液中精子参数相接近;2年内在检出精子的患者中随访其配偶自然受孕率为50.75％（34/67）,比WHO男性不育诊疗手册（2004版）中育龄人群2年内的自然受孕率（81％）低（P＜0.01）,与使用ICSI技术行双胚移植的临床妊娠率44.5％类似（P＞0.05）.结论 显微镜下附睾输精管吻合术后部分男性患者的生育力能够逐步恢复到正常育龄男性的水平,再通后射出精液中精子参数可恢复到正常育龄人群水平,其配偶在2年内的自然妊娠可与ICSI技术下行双胚移植的临床妊娠率相当.Objective To evaluate the male fertility after the epididymovasostomy. Methods The clinical data of 120 patients with obstructive azoospermia of epididymis undergoing epididymovasostomy from January 2005 to December 2011 in our hospital were retro- spectively analyzed. The recovery of sperm and the fertility status of the patients＇ wives were observed to evaluate the male fertility after 2 - year postoperative follow-up . Results The average operation time of 120 patients by in 2 - out 4 acupuncture therapy was （ 52.83 ±7.28 ） min. In 2-year follow-up, the sperm was found again from the ejaculating semen in 67 patients （ 55.83 % ）, including 18 patients in 1 month after the surgery,35 patients in 3 months after the surgery,and 14 patients in 6 months after the operation. After the operation,the average concentration of the sperm was 14.11 x 106/ml （95% CI ： 12.54 x 106 - 17.73 x 106 ）. The average progressive motility rate （PR） of the sperm was 30.89% （ 95% C1：28.42% - 33.04% ）. The average normal rate of the sperm was 5.21% （ 95 % C1：4.55% -6.52% ） , which was similar to the normal level of the sperm in the WHO semen analysis manual （2010）. The natural rate of the fertilization of the patients＇ wives was 50.75 %, which was lower than the normal rate （81% ） of male infertility in WHO （2004） （ P 〈 0.01 ） ,but it was smiliar to the rate of pregnancy with the intraeytoplasmic sperm injection（ICSI） with double embryo transplanta- tion （44.5 % ）. Conclusion The male fertility after the epididymovasostomy can recover to the normal level of man, and the sperm pa- rameters can also recover to the normal level of man, and the natural rate of the fertilization of the patients＇ wives is smiliar to the rate （44.5%） of pregnancy with the ICSI.

关 键 词：附睾输精管吻合术 男性生育力 妊娠率 

分 类 号：R698[医药卫生—泌尿科学]