梗阻性无精子症的定位诊断及病因分析

Localization and etiological analysis of obstructive azoospermia

目的探讨梗阻性无精子症的定位诊断及病因。方法回顾性分析2009年6月至2011年12月期间收治的47例梗阻性无精子症患者的临床资料，包括病史、查体、精浆生化检测、经直肠超声检查，通过手术探查最终确定的梗阻部位。结果47例梗阻性无精子症患者中，先天性双侧输精管缺如4例，精囊发育不良3例，射精管梗阻15例，双侧输精管梗阻5例，双侧附睾尾部梗阻13例，双侧附睾头部梗阻3例，附睾一侧头部对侧体部梗阻2例，附睾一侧体部对侧尾部梗阻2例。结论梗阻性无精子症的致病因素为先天发育不良及后天的炎症、创伤等，通过详细的病史采集、查体、精浆生化检测、经直肠超声检查，术前可对大部分梗阻部位作出判断。

Objective To investigate the localization and etiology of obstructive azoospermia. Methods The clinical data of 47 cases with obstructive azoospermia including medical history, physical examination, seminal plasma biochemistry, transrectal ultrasonography were retrospectively analyzed. The obstructive localization was confirmed by the surgical operation. Results Of 47 cases, 4 cases was congenital bilateral vas deference defect, 3 cases seminal vesicle aplasia, 15 cases ejaculatory duct obstruction,5 cases bilateral vas deference obstruction,13 cases bilateral cauda epididymis obstruction,3 casesbilateral caput epididymis obstruction,2 cases upper epididymis obstruction in different location, and 2 cases lower epididymis obstruction in different location. Conclusion Obstructive azoospermia may be caused by congenital aplasia and acquired reason such as infection and trauma. Mostly the location of obstruction can be determined by the medical history, physical examination, seminal plasma biochemistry and transrectal ultrasonography.