梗阻性无精子症的外科治疗(附56例报告)

Surgical treatment of obstructive azoospermia:A report of 56 cases

目的:探讨梗阻性无精子症的诊断和外科治疗方法。方法:分析2004年10月至2008年11月间收治的56例梗阻性无精子症患者的临床资料,其中43例为射精管梗阻性无精子症,13例疑为附睾水平梗阻性无精子症。常规精液分析、精浆果糖和中性α葡糖苷酶测定以及经直肠超声检查(TRUS)对其进行诊断,必要时行输精管造影检查。43例为射精管梗阻性无精子症使用经尿道射精管切开术(TURED)治疗,13例疑为附睾水平梗阻性无精子症行阴囊探查术,对其中11例确定为附睾水平梗阻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:所有患者均完成手术,术后随访3～51个月。43例射精管梗阻性无精子症TURED术后,36例(83.7%)精液检查有不同程度的改善,11例(25.6%)妻子妊娠。11例附睾水平梗阻性无精子症行输精管附睾吻合术后,6例(54.5%)精液检查检出活精子,3例(27.3%)妻子妊娠。结论:精液分析、精浆果糖和中性α葡糖苷酶测定,TRUS和输精管造影是诊断梗阻性无精子症的主要方式。TURED和输精管附睾吻合术分别是治疗射精管梗阻性无精子症和附睾水平梗阻性无精子症的有效方法。

Objective：To evaluate the diagnosis and surgical treatment of obstructive azoospermia. Methods：We analyzed the clinical data of 56 cases of obstructive azoospermia,43 of them with ejaculatory duct obstruction （EDO）,and the other 13 suspected of epididymal obstruction. The diagnostic methods included semen analyses,measurement of fructose and neutral α-glucosidase in the seminal plasma,transrectal ultrasonography （TRUS）,and vasography when necessary. The 43 patients with EDO were treated by transurethral resection of the ejaculatory duct （TURED）,and 11 of the 13 cases of suspected epididymal obstruction were confirmed by scrotal exploration and underwent either bilateral or unilateral vasoepididymostomy. The patients were followed up for 3-51 months for postoperative semen quality and impregnation. Results：Of the 43 azoospermia patients with EDO treated by TURED,36 （83.7%） showed improved semen parameters and 11 （25.6%） achieved pregnancies. Among the 11 cases of azoospermia with confirmed epididymal obstruction treated by vasoepididymostomy,6 （54.5%） had sperm in the semen assay and 3 （27.3%） achieved pregnancies. Conclusion：Semen analyses,measurement of fructose and neutral α-glucosidase in the seminal plasma,TRUS and vasography are important diagnostic methods for obstructive azoospermia. TURED is effective for azoospermia with EDO,while vasoepididymostomy is preferable for the treatment of azoospermia with epididymal obstruction.