获得性梗阻性无精子症的诊断和手术疗效分析  

Diagnosis of acquired obstructive azoospermia and surgical treatment outcome analysis

作　　者：江洪涛[1] 袁谦[1] 刘瑜[2] 刘增钦[1] 周振宇[1] 郭吉楠[1] 杨江根[1] 肖克峰[1] 

机构地区：[1]暨南大学第二临床医学院深圳市人民医院泌尿外科深圳市泌尿外科微创医学工程技术研究开发中心,518020 [2]暨南大学第二临床医学院深圳市人民医院生殖医学实验室,518020

出　　处：《中华泌尿外科杂志》2015年第7期538-542,共5页Chinese Journal of Urology

摘　　要：目的 探讨获得性梗阻性无精子症的诊断及外科治疗效果.方法 2009年1月至2014年5月诊断为获得性梗阻性无精子症患者106例,年龄22～46岁,平均30岁.不育病史2～16年,平均3年.精液常规检查并离心镜检均确认无精子.血清性激素检查均正常.71例有致孕史或精液正常史,35例睾丸功能未明确者睾丸活检结果示生精功能正常,提示为梗阻性无精子症.查体：外生殖器、阴囊均无异常.阴囊及经直肠前列腺、精囊腺彩色多普勒超声检查示无生殖道先天发育异常.术前均诊断为获得性梗阻性无精子症,接受手术治疗,其中探查手术15例,各种复通手术91例,包括经尿道钬激光射精管切开术11例、腹股沟区显微输精管吻合术6例、显微输精管吻合术10例、改进的输精管附睾横向套叠吻合术47例、不同术式结合使用17例.随访手术疗效,复查精液中精子密度＞ 10 000/ml定义为复通成功.结果 106例随访12 ～ 52个月.82例复通成功,9例失败,总体复通率90.1％ （82/91）.其中经尿道钬激光射精管切开术90.9％（10/11）,腹股沟区显微输精管吻合术83.3％（5/6）,显微输精管吻合术100.0％（10/10）,改进的输精管附睾横向套叠吻合术89.4％（42/47）,不同术式结合使用88.2％（15/17）.随访女方自然受孕32例.术后并发症包括发热、血精和阴囊切口延迟愈合各1例,经对症处理后均治愈,未发生严重并发症.结论 睾丸生精功能正常、生殖道发育无异常的无精子症患者可诊断为获得性梗阻性无精子症;采用手术治疗本病,恢复生殖道通畅性,可获得良好的疗效.Objective To study the diagnosis of acquired obstructive azoospermia and analyse the outcomes of surgical treatment.Methods One hundred and six patients were diagnosed with acquired obstructive azoospermia at our center between January 2009 and May 2014.A total of 106 patients aged from 22 to 46 years （mean age：30 years old）,their duration of infertility were 2 to 16 years,mean 3 years.All patients had clinic findings related to azoospermia,including no sperm found in semen analyses and centrifuged semen sample,normal scrotal ultrasonogram and serum sex hormone,71 cases with a history of natural conception or normal semen analyses,35 cases with a normal level of spermatogenesis confirmed by testicular biopsy.Physical examination and ultrasonography of the genital system shown that the seminal duct were normally developed in all patients.One hundred and six patients with acquired obstruction were treated by multiple surgical techniques and follwed-up.Of them,15 surgical explorations and 91 reconstructions,including 11 transurethral incision of ejaculatory duct with holmium laser,6 microscopic vasovasostomy at inguinal region,10 microscopic vasovasostomy,47 modified transverse intussusception vasoepididymostomy and 17 combined surgical techniques.Patency was defined as 〉 10 000 sperm/ml of semen.Results The postoperative follow-up time was 12 months to 52 months.Eighty two had return of sperm to ejaculate and nine failed,the overall patency rate was 90.1% （82/91）.The patency rate was 90.9% （10/11） 、83.3% （5/6） 、100.0% （10/10）、89.4% （42/47）、88.2% （15/17）for transurethral incision of ejaculatory duct with holmium laser,microscopic vasovasostomy at inguinal region,microscopic vasovasostomy,modified transverse intussusception vasoepididymostomy and combined surgical techniques,respectively.Thirty two patients naturally achieved conception.Postoperative complications included one case of fever,one hemospermia and one delayed wound healing at scrotum,all were cured by medication.No

关 键 词：无精子症 诊断 外科治疗 

分 类 号：R698.2[医药卫生—泌尿科学]