医源性输精管损伤致梗阻性无精子症的诊断和外科治疗  

Diagnosis and surgical treatment of obstructive azoospermia due to iatrogenic vas duct injury

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

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,深圳518020

出　　处：《中华泌尿外科杂志》2016年第1期52-56,共5页Chinese Journal of Urology

基　　金：深圳市科技计划基础研究项目（JCYJ20150403101028174）

摘　　要：目的 探讨医源性输精管损伤致梗阻性无精子症的诊断及外科治疗.方法 2010年1月至2014年6月收治的因腹股沟区手术导致的无精子症患者11例.年龄23-37岁,平均27岁.9例为双侧腹股沟区输精管损伤,2例为单侧输精管损伤并对侧隐睾或睾丸肿瘤根治性切除术后.经阴囊查体、精液常规检查并离心镜检、精浆生化、生殖道彩色多普勒超声、血清性激素等检查初步诊断为梗阻性无精子症.1例合并隐睾者中性α糖苷酶正常,余10例中性α糖苷酶为2.4-7.4 mU/次射精,平均4.4 mU/次射精（正常值为＞20.0 mU/次射精）.11例均全麻下行腹股沟区探查术.早期的4例由于输精管缺损段过长和/或远段回缩入盆腔、继发附睾梗阻,术前未准备腹腔镜设备和不具备显微输精管附睾吻合技术而放弃复通手术;后期7例中,6例根据输精管缺损部位、长度和继发附睾梗阻情况采用腹腔镜辅助显微输精管吻合术、单纯显微输精管吻合术以及改进的横向开窗式显微输精管附睾套叠吻合术,1例因盆腔段输精管萎缩放弃复通手术.以术后复查精子密度＞1×10^6/ml定义为复通成功.结果 6例行复通手术的患者,术后1-3个月复查,5例输精管复通成功;1例术后无精子.5例复通成功者术后随访6-32个月,平均18个月,女方自然受孕2例.余6例患者建议采用卵母细胞胞质内单精子注射法行辅助生育.结论 中性α糖苷酶明显低于正常是判断输精管损伤的重要指标.手术治疗医源性输精管损伤致梗阻性无精子症患者的疗效良好,腹腔镜设备和显微输精管附睾吻合技术对于手术修复起着至关重要的作用。Objective The goal of this study was to analyze the diagnosis of azoospermia caused by iatrogenic vas duct injury and evaluate the outcomes of surgical treatment.Methods Eleven patients, whose age ranged from 23 to 37 years old （mean 27 years old）, with azoospermia caused by iatrogenic vas duct injury were consecutively admitted in our single center between January 2010 and June 2014.The characters of those patients included 9 cases of bilateral vas duct injury, 2 cases of unilateral vas duct injury with contralateral cryptorchidism or orchiectomy.All patients accepted scrotal physical examination, semen analysis, seminal plasma test, seminal duct Doppler ultrasonography, serum sex hormone and then diagnosed as obstructive azoospermia.Except one patient with unilateral cryptorchidism had normal seminal nutral α-glucosidase, other 10 patients had significantly low nutral αt-glucosidase, ranged from 2.4 to 7.4 mU/once ejaculate （mean 4.4 mU/ejaculation）.All patients accept the inguinal surgical exploration.The early 4 patients were unable to be treated with surgical reconstruction due to the large defect of vas duct, failure to find distal vasal stump and secondary epididymal obstruction.Meanwhile, laparoscopic equipments and microscopic techniques were not prepared preoperatively.In the late 7 cases, six underwent simple vasovasostomy, laparoscopic-assisted vasovasostomy, and modified vasoepididymostomy based on length and sites of vasal injuries and condition of secondary epididymal obstruction.One failed to be reconstructed due to pelvic vas atrophy.The definition of successful recanalization was the density of sperm more than 1 × 10^6/ml during the postoperative follow-up.Results All patients had iatrogenic vas duct injury.Among six treated patients, five patients achieved recanalization, except one case was still azoospermia.The duration of follow-up in those five patients ranged from 6 to 32 months （mean 18 months）.During following-up, naturally achieved pregnancy was recorded in two couples.Th

关 键 词：男性不育 无精子症 医源性损伤 腹腔镜 显微手术 

分 类 号：R699[医药卫生—泌尿科学]