146例炎症梗阻性无精子症的临床评估和ICSI治疗结局分析

The analysis of clinical characteristics and the results of ICSI in 146 cases with post-inflamatory obstructive azoospermia

目的分析炎症梗阻性无精子症的临床评估和单精子卵胞浆内注射(ICSI)的治疗结局。方法前瞻性研究近5年间接受ICSI治疗的炎症性梗阻性无精子症的临床特征、精液和超声特点,经皮附睾穿刺精子抽吸术(PESA)或经皮睾丸穿刺取精术(TEFNA)结合ICSI治疗后观察受精、临床妊娠等结果。结果146例患者体检附睾均有增粗变硬或伴头尾部结节。82例患者曾有生育史、附睾炎症史或输精管附睾吻合手术史,其中72例PESA找到附睾精子;53例无上述病史者49例PESA找到附睾精子:另有精道远端梗阻11例。ICSI治疗146例167周期炎症性梗阻性无精子症的受精率、每周期临床妊娠率分别为81.1%和42.1%。结论炎症梗阻性无精子症具备典型的临床和超声特征,PESA附睾精子获取率高,ICSI治疗获得较高受精率和临床妊娠率。

Objective To analyse the clinical features and the ICSI results in the cases with post-inflammatory obstructive azoospermia. Methods From Jan.2003 to Dec.2007, the cases with obstructive azoospermia visited in our hospital were underwent history inquiry, physical examination, semen analysis, scrotal and transrectal ultrasonography. Percutaneous epididymal sperm aspiration （PESA） or testicular fine needle aspiration （TEFNA） was employed to retrieve spermatozoa for ICSI after definitive diagriosis had made. And then the outcomes of ICSI were observed. Results The enlarged and hardened epididymis or nodules in the epididymis were observed in all the 146 cases with post-inflammatory obstructive azoospermia. In 82 patients with a fathering history, previous epididymitis or previous vasoepididymostomy, the sperm could be found by PESA in 72 cases or by TEFNA in other 10 cases. In 53 patients without definitely post-inflammatory or surgical history, the sperm could be found by PESA in 49 cases or by TEFNA in other 4 cases. 11 cases with seminal ducts distal obstruction were confirmed by seminal analysis, ultrasonography as well as PESA. The fertilization rate and clinical pregnancy rate per transference of ICSI cycle was 81.1% and 42.1%, respectively. Conclusion The classical clinical features of the cases with post-inflammatory obstructive azoospermia were with fathering history or previous epididymitis history, and with enlarged and hardened epididymis or nodules in the epididymis. The sperm could be found in the epididymal fluid in most of them. ICSI is one of the effective treat- ments with promising outcomes to deal with such cases.