输精管造影术对无精子症诊断价值及治疗作用的临床探讨

Clinical Investigation of Diagnostic Value and Therapeutic Effects of Vesiculography on Azoospermatism

目的:探讨输精管造影术在无精子症中的诊断价值及治疗作用。方法:对近2年在本院诊治的38例无精子症患者,采用经皮输精管穿刺精道造影术的方法,对其造影的结果进行统计分析。结果:成功穿刺36例,其中输精管道通畅25例,射精管梗阻3例(其中2例伴精囊积水);输精管梗阻2例;精囊炎症闭锁2例;射精管粘连、充盈缺损4例,膀胱内均有造影剂存在,术后给予抗生素口服4～8天,先后于15～60d内复查精液常规可见大量存活精子,其中2例造影前精浆生化检测见a-中性糖苷酶及果糖含量正常。结论:输精管造影术在诊断无精子症中的重要价值是精浆生化检测所不能替代的,且对因炎症粘连尚未纤维化及瘢痕形成所致的射精管梗阻有一定的治疗作用。

Objective： To investigate the diagnostic value and therapeutic effects of vesiculography on azoospermatism. Methods ： 38 cases of azoospermatis, who received treatment from our hospital in recent 2 years, were recruited into this study. Vesiculography through percutaneous vasopuncture were adopted, and the results of vesiculography were statistically analyzed. Results： 36 cases were operated successfully, in which 25 cases with smooth deferens and 3 cases with ejaculatory duct obstruction （of which 2 cases with seminal vesicle hydrops）. There were 2 cases with deferens obstruction, 2 cases with inflammatory atresia of seminal vesicle and 4 cases with ejaculatory duct adhesion and filling defect. And radiopaque materials were detected in bladders among these 4 cases. After oral antibiotics for 4 -8 days, semen routine was operated within 15 -60 days, and a large number of living sperms were detected. Normal levels of α- glucosidase and fructose were detected through seminal plasma biochemistry before vesiculography in 2 cases among them. Conclusion ： Vesiculography is valuable in the diagnosis of azoospermatism, which can not be replaced by seminal plasma biochemistry. Even vesiculography can play important roles in the treatment for ejaculatory duct obstruction caused by non -fibrosis inflamed adhesion and synulosis.