前列腺按摩取精结合精浆生化指标检测对梗阻性无精子症患者治疗方案选择的指导意义  

The guiding significance of prostate massage combined with seminal plasma biochemical indicators in the treatment of obstructive azoospermia patients

作　　者：张太健 陈砼 许超 朱林凯 刘晓丹 张浩波 马刚 唐蓉 玄绪军 ZHANG Taijian;CHEN Tong;XU Chao;ZHU Linkai;LIU Xiaodan;ZHANG Haobo;MA Gang;TANG Rong;XUAN Xuju(Department of Urology and Male Reproductive Medlicine,Hospital for Reproductive Medicine Affiliated to Shandong Uninversity,Jinan 250021,Shandong,China;National Research Center for Assisted Reproductive Technology and Reproducative Genetics,Jinamn250021,Shandong,China;Department of General Surgery,The Affiliated Children's Hospital,Shanghai JiaotongUniversity,Shanghai 200240,China;Department of Andrology,The Seoenth Affliated Hospital,Sun Yat-sen Uni-versitly,Shenzhen 518107,Guanglong,China;Department of Climical Laboratory,Hospital for Reproductine Medi-cine Affiliated to Shandong University,.Jinan 250021,Shandong,China255020,Shangong,China)

机构地区：[1]山东大学附属生殖医院泌尿外科和男性生殖科,济南250021 [2]国家辅助生殖与优生工程技术研究中心,济南250021 [3]上海交通大学附属儿童医院普外科,上海220240 [4]中山大学附属第七医院男科中心,广东深圳018107 [5]山东大学附属生殖医院医学检验科,济南250021

出　　处：《中国性科学》2020年第12期1-4,共4页Chinese Journal of Human Sexuality

基　　金：山东省医药卫生科技发展计划项目(2019WS174)。

摘　　要：目的探讨前列腺按摩结合精浆生化指标检测对梗阻性无精子症(OA)患者的临床意义。方法选取2017年10月至2019年2月山东大学附属生殖医院门诊初步诊断为OA而行前列腺按摩的206例患者作为研究对象。根据检查患者前列腺液中有无精子分为获得精子组(A组,n=15)和未获得精子组(B组,n=191)。对两组患者的基线资料、精浆生化水平、治疗结局等临床资料进行分析。结果206例患者中7.28%获得精子。A组患者的精液量、精浆果糖、弹性硬蛋白酶(PMN-Elastase)水平均低于B组,差异具有统计学意义(P<0.05),而两组患者中性α-葡糖苷酶(NAG)水平比较,差异无统计学意义(P>0.05)。A组患者其中11例患者行经尿道射精管口切开术(TURED)治疗,术后患者的精液量、精子浓度、精浆果糖均明显改善,术前术后比较差异有统计学意义(P<0.01)。另4例患者通过前列腺按摩取精后行卵细胞质内单精子注射(ICSI)。B组患者行附睾穿刺活检(PESA)或经皮睾丸穿刺活检术(TESA)。结论对果糖很低甚至为0、无隐性感染,精液量少的OA患者,尝试采取前列腺按摩取精是一个简单易行的选择,这部分患者行前列腺按摩可能取到精子并可以确诊部分射精管口梗阻(EDO)患者,对指导下一步治疗方案的选择,有较好的临床意义。Objective To explore the clinical significance of prostate massage combined with seminal plasma biochemical indicators in patients with obstructive azoospermia(OA).Methods 206 patients who were initially diagnosed as OA and underwent prostate massage in the outpatient department in the Hospital for Reproductive Medicine Affiliated to Shandong University from October 2017 to February 2019 were selected as research objects,and divided into the acquired spermatozoa group(group A,n=15)and the non-acquired spermatozoa group(group B,n=191)according to the presence or absence of spermatozoa in the prostatic fluid.The baseline data,seminal plasma biochemical level,treatment outcome and other clinical data of the two groups were analyzed.Results Sperm was obtained in 7.28%of 206 patients.The levels of seminal fluid,spermatic berry sugar and PMN-Elastase in group A were all lower than those in group B(P<0.05),while NAG levels in the two groups were not significantly different(P>0.05).In group A,11 patients underwent TURED.Semen volume,sperm concentration and spermatic berry sugar of postoperative patients were all significantly improved,showing statistically significant differences(P<0.05).The other four patients underwent intracytoplasmic sperm injection(ICSI)after sperm extraction by prostate massage.In group B,patients underwent PESA or TESA.Conclusions For OA patients with low fructose(even 0),no hidden infection,and low semen volume,it is a simple and easy option to try prostate massage to get the sperm.These patients may get the sperm and be diagnosed EDO by prostate massage.This method has good clinical significance for guiding the selection of the following treatment plan.

关 键 词：男性不育 梗阻阻性无精子症 前列腺按摩 果糖 中性α-葡糖苷酶 

分 类 号：R691.2[医药卫生—泌尿科学]