近段输精管道获得性梗阻性无精子症经阴囊超声特征分析

Scrotal ultrasonographic features of acquired obstructive azoospermia of proximal deferent duct

目的探讨近段输精管道获得性梗阻性无精子症的经阴囊超声表现。方法对92例近段输精管道获得性梗阻性无精子症患者(病例组)行经阴囊超声检查,其中附睾炎性梗阻79例,输精管医源性梗阻13例(2例合并对侧附睾炎性梗阻),观察睾丸、附睾、阴囊段输精管的声像图表现。以65例精液检查正常者为对照组。结果病例组与对照组睾丸体积比较,差异无统计学意义(P>0.05)。92例患者184条附睾声像图均出现异常,其中附睾头、体、尾部的厚度与对照组比较,差异均有统计学意义(P<0.05);声像图表现为附睾整条或局部增厚,增厚部位附睾管扩张,呈细网状改变,附睾管内径为0.03 cm。39条(24.4%)炎性梗阻的附睾内合并出现炎性偏高回声结节。在160条附睾炎性梗阻的阴囊段输精管中,159条(99.4%)平均内径与对照组相同。24条医源性梗阻患者手术近端输精管均为扩张状态。结论近段输精管道获得性梗阻性无精子症由于梗阻的原因和部位不同,附睾与输精管存在不同特征的声像图表现,经阴囊超声可为该类疾病的诊断提供可靠的影像学依据。

Objective To investigate the scrotal ultrasonographic features of acquired obstructive azoospermia of proximal deferent duct. Methods Ninety-two cases of acquired obstructive azoospermia of proximal deferent duct(case group) were evaluated by scrotal ultrasonography.Among the 92 cases,79 were epididymal post-infective obstructive azoospermia,the other 13 were vas deferens post-surgical obstructive azoospermia(one side was post-surgical,while the other was post-infective in 2 cases).The ultrasonographic features of testis,epididymis and scrotal segments of vas deferens were observed.Another 65 cases with normal semen were served as control group. Results There was no significant difference in testicular volume between case group and control group(P>0.05).The ultrasonographic appearance was abnormal in 184 epididymis of all the 92 cases,and the epididymal head,body and tail were all significantly thicker than those of control group(P<0.05).The epididymal duct in the thickening of epididymis were ectatic,exhibiting micro-reticulate changes,with inner diameter of 0.03 cm.Thirty-nine(24.4%) post-infective obstructive epididymis presented high echo inflammatory nodules.The mean inner diameter of scrotal segments of vas deferens of 159 sides(99.4%)in 160 epididymal post-infective obstructive azoospermia was similar to that of the control group.The vas deferens of the proximal surgery side were all expanded in 24 vas deferens post-surgical obstructive azoospermia. Conclusion Because of different location of obstruction and causes in acquired obstructive azoospermia of proximal deferent duct,there are different features of the epididymis and vas deferens of the ultrasonographic appearance,and scrotal ultrasonography can provide credible sonogram evidence for the diagnosis.