附睾输精管吻合术治疗梗阻性无精子症

Vasoepididymostomy for the treatment of obstructive azoospermia

目的探讨附睾输精管吻合术在梗阻性无精子症治疗中的作用.方法选择23例确诊为梗阻性无精子症并初步怀疑为附睾水平梗阻的患者进行阴囊探查,观察睾丸、附睾及输精管情况,对其中19例确定为附睾水平梗阻并在附睾液中找到活精子的患者用8-0尼龙线施行双侧或单侧附睾输精管端侧吻合术,术后随访其疗效.结果19例获随访8～34个月,9例(47%)于术后3～9个月从精液中检出活精子,其中5例配偶受孕成功.结论阴囊探查简单、易行,有助于梗阻性无精子症的诊断和治疗,附睾输精管吻合术治疗梗阻性无精子症取得初步效果,值得进一步探讨.

ObjectiveTo evaluate the efficacy of vasoepididymostomy for the treatment of obstructive azoospermia.MethodsA total of 23 patients with obstructive azoospermia who were suspected of obstruction of epididymal tubule underwent scrotal exploration for detection of testis, epididymis and vas deferens.Of them 19 patients who were confirmed to have epididymal obstruction underwent either bilateral or unilateral vasoepididymostomy.Postoperative semen assay,postoperative patency rate and postoperative impregnation rate were followed.ResultsAll the 19 cases who underwent vasoepididymostomy were followed up postoperatively for 8-34 months.Three to 9 months following surgery 9 patients had sperm in the semen assay,with an overall patency rate of 47% (9/19);of them 5 patients achieved impregnation,with a postoperative impregnation rate of 26% (5/19).ConclusionsScrotal exploration is a simple,time-saving and effective technique for both diagnosis and treatment of obstructive azoospermia suspected of obstruction of epididymal tubule.Vasoepididymostomy is effective in some of the patients with obstructive azoospermia,and further investigation is needed.