多囊肾并精道动力梗阻性无精症一例报告并文献复习  

Functional obstructive azoospermia with autosomal dominant polycystic kidney disease:a case report and literature review

作　　者：张浩[1] 杨晓健[2] 刘小彭[1] 司徒杰[1] 周祥福[1] 高新[1] 张炎[2] Zhang Hao;Yang Xiaojian;Liu Xiaopeng;Situ Jie;Zhou Xiangfu;Gao Xin;Zhang Yan(Department of Urology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Infertility and Sexual medicine,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院泌尿外科,广州510630 [2]中山大学附属第三医院不育与性医学科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2020年第5期370-372,共3页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金(81771565);广东省基础与应用基础研究基金(2019A1515010975)资助。

摘　　要：目的回顾一例多囊肾并精道动力梗阻性无精症的诊疗经过,探讨该类型无精症的治疗要点。方法29岁男性无精症患者,彩超资料显示精囊囊性扩张、输精管阴囊段及盆腔段扩张,精液量0.2 ml,初诊射精管梗阻性无精症,予行双侧输精管探查并经尿道射精管切开术治疗。结果术中发现输精管及附睾管道通畅,左侧输精管往远睾端推注美蓝阻力大,予以行射精管切开,患者术后持续发热,再次行精囊镜检查冲洗控制感染。术后1年精液随访:精液量4.2 ml,无精子。结论多囊肾并发的无精症,往往为精道动力梗阻性无精症,原因是多囊肾伴随引起的精囊囊性改变、输精管长期扩张,导致精道动力缺乏,这种类型的无精症发病原因往往并不是射精管梗阻,采取射精管切开手术治疗,术后无法恢复精道正常蠕动能力,往往治疗无效。Objective To explore the treatment of a case of functional obstructive azoospermia with autosomal dominant polycystic kidney disease.Methods 29-year-old azoospermia male with sperm volumn was 0.2 ml,ultrasound showed seminal and vas megavesicles.The primary diagnosis was ejaculatory duct obstruction and the surgery of bilateral vas exploration and transurethral resection of ejaculatory ducts(TURED)were performed.Results Instillation of methylene blue dye can be seen from the bilateral ejaculatory ducts at the time of cystoscopy although the stream of left side was less than the right side.The verumontanum was deeply resected down to the ejaculatory ducts.The patient got fever after surgery and underwent cystoscopy to clear the infection.The postoperative semen analysis revealed that the semen contained no spermatozoa although with increasing of the sperm volume(4.2 ml).Conclusion Seminal megavesicles with autosomal dominant polycystic kidney disease may lead to obstructive azoospermia.It looked like“functional obstruction”but not only“mechanical obstruction”.The obstruction was probably due to partial through compression of the ductal system but mainly because of the failure of the vas deferens and seminal vesicles to contract effectively,which called dyskinesia.TURED was less effective in the treatment of this situation.

关 键 词：多囊肾 梗阻性无精症 精囊扩张 动力缺乏 

分 类 号：R698.2[医药卫生—泌尿科学]