先天性输精管缺如的临床特点与诊疗策略

Clinical Features & Diagnostic and therapeutic Strategies of Congenital Absence of the Vas Deferens

目的:探讨先天性输精管缺如(CAVD)的临床特点,提高其诊断和治疗水平。方法:分析81例CAVD患者的临床诊治资料,总结其临床特点、诊断和治疗方法。结果:79例因不育就诊,从有生育要求到确诊平均经过4.8年;2例术中探查发现。先天性双侧输精管缺如(CBAVD)40例,先天性单侧输精管缺如(CUAVD)25例,节段性输精管缺如16例。74例患者的配偶接受辅助生殖治疗,其中12例接受卵细胞胞质内单精子注射(ICSI)治疗,4例成功妊娠。结论:CAVD患者多以不育就诊。CBAVD均表现为梗阻性无精子症;CUAVD和节段性缺如者可表现为少精子症、弱精子症或梗阻性无精子症。本病诊断多无困难,但常因体检不仔细而漏诊。CAVD治疗的原则主要是恢复患者的生育能力,可借助辅助生殖技术(ART)进行治疗。

Objective： To investigate the clinical characteristics, diagnosis and therapeutic strategies of congenital absence of the vas deferens （CAVD）. Methods： We summarized the clinical data of 81 cases of CAVD and investigated clinical features, diagnosis and management of the disease. Results： Seventy-nine cases of infertility were diagnosed as CAVD at the clinic, and 2 were diagnosed during surgical exploration. The population consisted of 40 cases of congenital bilateral absence of the vas deferens （CBAVD） , 25 cases of congenital unilateral absence of the vas deferens （CUAVD） , and 16 cases of segmental agenesis of the vas deferens. Seventy- four spouses received the treatment of assisted reproductive techniques, including intracytoplasmic sperm injection （ICSI） in 12 cases, and 4 of them achieved pregnancy, Conclusion： CAVD frequently presents with infertility. CBAVD may manifest as obstructive azoospermia, and CUAVD and segmental vasal agenesis as oligospermia, asthenospermia, or obstructive azoospermia. CAVD is usually not difficult to dignose, but may be missed due to careless examination. Assisted reproductive technology （ART） plays a key role in the management of CAVD. Natl J Androl,2005 ,11 （11） ：818-821