CBAVD患者超声分型在临床取精方式选择中的意义  

The significance of ultrasonic typing of CBAVD patients in the selection of clinical semen extraction methods

作　　者：顾怡栋 邓学东[1] 程洪波[2] 汪璐赟 杨慎敏[2] GU Yidong;DENG Xuedong;CHENG Hongbo;WANG Luyun;YANG Shenmin(Center of Medical Ultrasound,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,Jiangsu,China;Center for Reproduction and Genetics,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,Jiangsu,China)

机构地区：[1]南京医科大学附属苏州医院,苏州市立医院超声中心,江苏苏州215002 [2]南京医科大学附属苏州医院,苏州市立医院生殖与遗传中心,江苏苏州215002

出　　处：《西部医学》2020年第1期130-134,共5页Medical Journal of West China

基　　金：苏州市临床医学中心资助项目(Szzx201505);苏州市“科教兴卫”青年科技项目(kjxw2015020)

摘　　要：目的探讨先天性双侧输精管缺如(CBAVD)患者超声分型在临床取精方式选择中的意义。方法选取南京医科大学附属苏州医院97例CBAVD患者,对其临床资料行回顾性分析。所有患者均行临床体格检查、精液分析、血清性激素水平检测、CFTR基因△F508突变位点检测、经阴囊与经直肠超声检查、双侧肾脏超声检查后穿刺取精并行卵胞浆内单精子显微注射技术(ICSI)治疗。结果 97例CBAVD患者经阴囊与经直肠超声检查显示输精管道缺如的部位不尽相同,依据附睾结构是否完整对CBAVD患者行超声分型,可分为附睾完整的CBAVD和附睾不完整的CBAVD两种类型,其中附睾不完整的CBAVD又可分为四种亚型,即双侧附睾均缺如;双侧附睾体、尾部缺如;双侧附睾体截断征,附睾尾部缺如;一侧附睾体、尾部缺如。依据不同超声分型选择合适的穿刺取精术,并以行ICSI治疗后经阴道超声检查显示妊娠囊及心管搏动为临床妊娠标准,不同超声分型的CBAVD患者穿刺取精后临床妊娠率的差异无统计学意义(P>0.05),即行经皮附睾精子抽吸术(PESA)的患者和行睾丸穿刺取精术(TESA)的患者在行卵胞浆内单精子显微注射技术(ICSI)治疗后临床妊娠率无明显差异(P>0.05)。结论 CBAVD超声分型显示了输精管道缺如的具体部位,为临床行ICSI治疗前选择合适的穿刺取精术提供了依据,避免因不必要的临床操作而增加患者痛苦。不同超声分型的CBAVD患者穿刺取精并行ICSI治疗后临床妊娠率无明显差异。Objective To explore the significance of ultrasound typing in the selection of clinical semen extraction methods in patients with congenital bilateral absence of vas deferens(CBAVD). Methods The clinical data of 97 patients with CBAVD in Suzhou Hospital Affiliated to Nanjing Medical University were analyzed retrospectively. All patients were treated with clinical physical examination, semen analysis, serum sex hormone level, CFTR gene △ F508 mutation site, scrotal and transrectal ultrasound, bilateral kidney ultrasound and ICSI. Results 97 cases of CBAVD patients showed different locations of the absence of vas deferens by scrotal and transrectal ultrasonography. According to whether the structure of epididymis is complete, the patients can be divided into two types of CBAVD with intact epididymis and CBAVD with incomplete epididymis. The CBAVD with incomplete epididymis can be divided into four subtypes, namely, the absence of both epididymis, the absence of both epididymis and tail, and the absence of both epididymis One side epididymal body and tail are absent. According to different types of ultrasound, select the appropriate puncture and semen extraction, and take the transvaginal ultrasound examination after ICSI treatment to show the pulsation of gestational sac and heart tube as the clinical pregnancy standard. There was no significant difference in the clinical pregnancy rate after puncture and semen extraction in patients with different types of ultrasound(P>0.05). There was no significant difference in the clinical pregnancy rate between the patients with PESA and the patients with Tessa after ICSI(P>0.05). Conclusion The ultrasonic classification of CBAVD shows the specific location of the absence of the vas deferens, which provides the basis for the selection of appropriate puncture and semen extraction before ICSI treatment, and avoids the pain of patients caused by unnecessary clinical operation. There was no significant difference in the clinical pregnancy rate after ICSI treatment in different

关 键 词：无精子症 经阴囊超声检查 经直肠超声检查 输精管缺如 

分 类 号：R445.1[医药卫生—影像医学与核医学]