经尿道精囊镜技术—一种治疗射精管梗阻性无精子症的新方法

Transurethral seminal vesiculoscopy—a new treatment method for azoospermia from ejaculatory duct obstruction

目的探讨经尿道精囊镜技术治疗射精管梗阻性无精子症的可行性和有效性。方法分析我科自2007年1月至2009年7月采用经尿道精囊镜技术诊治射精管梗阻性无精子症患者21例的临床资料,术前均明确诊断为射精管梗阻性无精子症,术后定期随访患者精液常规及配偶的妊娠情况。结果本组病例年龄23～36岁,平均年龄28.8岁,所有病例术中均可见射精管狭窄或梗阻,5例患者并可见射精管或精囊中结石,11例患者术后1～3个月内可查及精液中精子,8例在3～12个月内精液常规可查见精子,7例精浆果糖恢复至阳性,4例患者配偶术后8～12个月妊娠,2例患者术后随访12个月未发现精液中精子。所有病例术后均未见附睾炎、逆行射精、尿失禁或直肠损伤等并发症。结论经尿道精囊镜技术安全、有效、可行,是一种治疗射精管梗阻性无精子症的新方法。

Objective To investigate the feasibility and effect of Transurethral seminal vesiculoscopy for treatment of ejaculatory duct obstruction （EDO） azoospermia. Methods From January of 2007 to July of 2009, clinical data of 21 EDO azoospermia cases treated with Transurethral seminal vesiculoscopy were analyzed. All cases were diagnosed as EDO azoospermia before operatiion. The patients＇ semen analysis and their spouse＇ s cyesis were followed up postoperative. Results Age of patients was from 23 to 36 years, the average was 28.8 years old. All cases were found to have ejaculatory duct stenosis or obstruction during operation and moreover 5 cases had calculus in ejaculatory duct or seminal vesicle. Semen analysis was followed up for all cases. Sperm was detected in 11 cases within 1 to 3 months after surgery and another 10 cases were found within 3 to 12 months. Seven cases had seminal plasma fructose positive, 4 patients＇ spouses were pregnant in 8 to 12 months after surgery. The complications such as epididymitis, retrograde ejaculation, urinary incontinence and rectal injury were not observed in all treated patients. Conclusion Transurethral seminal vesiculoscopy is safe, effect and feasible in the treatment of ejaculatory duct obstruction azoospermia.