428例无精子症患者病因分析

Etiology of Azoosepermia： clinical analysis of 428 cases.

目的研究男性不育无精子症病因的构成比情况，提高无精子症的诊断水平，判断预后，指导治疗。方法对笔者所在医院不孕不育科2年多来428例诊断为无精子症的病例，按照WHO的诊断分类标准进行回顾性分析。结果在428例无精子症中，先天性异常152例（35．5％），精索静脉曲张150例（35．0％），梗阻性无精子症47例（11％），特发性无精子症33例（7．7％），继发性睾丸损伤31例（7．2％），内分泌病因15例（3．5％）。结论本组男性不育无精子症的主要病因为先天性异常、精索静脉曲张，其次为梗阻性无精子症。无精子症一般预后较差，辅助生殖技术是其治疗的常用方法，但若能关注无精子症的病因研究，早期诊断、早期预防、早期治疗，是可以防止一些无精子症的发生或发展，甚至可使部分无精子症患者病情好转而产生精子。

Objective To investigate the various etiologies of azoospermia in infertile male so that to improve diagnosis of azoospermia and to guide management. Methods Retrospective analysis according to WHO classification of 428 cases of azoospermia infertile males seen in this clinic during last two years. Results The series consisted 152 cases of congenital abnormalities （35.5%）, 150 cases of varicocele（35. 0% ）, 47 cases of obstructive azoospermia （ 11% ）, 31 cases of secondary trauma to testis （ 7.2% ）, 15 cases of endocrinopathy （ 3.5 % ） and 33 cases of idiopathic azoospermia（7.7% ）. Conclusion The most common causes of azoospermia in this series were congenital abnormality and varicocele,followed by obstructive azoospermia. Azoospermia has a poor prognosis of natural conception and assisted reproductive technology is commonly needed to achieve pregnancy. More attention should be paid to exploring the etiology of azoospermia. Early diagnosis with appropriate management may prevent from deterioration,even restore spermatogenesis in some cases.