500例无精子症诊治的回顾性分析

Retrospective Analysis of Azoospermia:A Report of 500 Cases

目的：回顾分析500例无精子症的临床诊治,为提高男性不育症规范化诊治水平提供参考。方法：回顾性分析2012年12月—2013年12月间收治的无精子症患者500例,根据中华医学会2013版《男科疾病诊治指南系列男性不育症诊疗指南》诊断为梗阻性、非梗阻性、混合性无精子症;分别提供附睾、输精管、射精管等精道重建手术、药物治疗、体外受精（IVF）/胞浆内单精子注射（ICSI）、供精人工授精（AID）及收养等方案供患者夫妇知情选择。结果：500例中梗阻性无精子症254例、非梗阻性无精子症187例、混合性无精子症40例,Y染色体AZFa或AZFb微缺失所致的无精子症19例。手术治疗的44例患者中,14例接受精囊镜射精管囊肿切开术、5例接受输精管-输精管吻合术、25例接受输精管-附睾吻合术;其中33例在术后3-12个月内行精液检查发现精子,2例在术后3-8个月女方自然妊娠;药物治疗的19例患者中,7例炎症性梗阻患者给予抗生素治疗1-3个月后,3例在3-6个月精液检查时发现精子,其中1例在治疗后5个月内女方自然妊娠,其余4例患者的生殖系统不适症状较前明显缓解;12例低促性腺激素患者给予卵泡刺激素（FSH）和（或）人绒毛膜促性腺激素（h CG）治疗,其中包括1例Kallmann综合征,9例患者经3-12个月随访,睾丸体积明显增大（〉4-8 m L）,血清睾酮明显增高,其中5例在6-12个月内精液中出现精子;IVF/ICSI治疗组的376例患者12个月内成功妊娠者196例;其余61例选择AID或收养。结论：依据中华医学会《男科疾病诊治指南系列男性不育症诊疗指南》谨慎有创操作,倡导医患共同决策诊疗行为,对于临床上无精子症规范化与合理的诊治具有积极意义。

Objective： To analyse retrospectively the clinical diagnosis and treatment of 500 cases with azoospermia, so as to act up to the normalized diagnosis and treatment of male infertility. Methods：Five hundreds cases with azoospermia infertility, from December 2012 to December 2013 in our center, were retrospectively analyzed. According to the 2013 Chinese Medical Guideline of Male Infertility, those patients were divided as：obstructive azoospermia, non-obstructive azoospermia and the mixed azoospermia. Mutiple treatments, such as the reconstructive surgery, medication, IVF/ICSI, AID and adoption, were advised to choose with a informed consent.Results：There were 254 cases with obstructed azoospermia, 187 cases with non-obstructed azoospermia and 40 cases with the mixed azoospermia in those 500 cases, and 19 cases were diagnosed as the microdeletion in AZFa or AZFb gene. In 44 cases underwent reconstructive surgery, there were 14 cases accepted the ejaculatory duct cyst incision by seminal vesicle mirror, 5 cases accepted the anastomosis of deferens and deferens, 25 cases accepted the anastomosis of deferens and epididymis. Sperms were found in 33 cases after 3-12 months of surgery, nature uxorial pregnancies were found in 2 cases. In 19 cases underwent medication, 7 patients with inflammatory obstruction were treated with antibiotics for 1-3 months. Sperms were found in 3 cases（3/7） after3-6 months of treatment, one case had nature uxorial pregnancy, and 4 cases had significant improvement in their symptoms of reproductive system. Twelve cases with hypogonadism were treated with r FSH or h CG, including one case with Kallmann syndrome. Nine cases had the increased testicular volume（〉4-8 m L） and the increased testosterone concentration in their 3-12 months follow-up, while sperms were found in 5 cases in their 6-12 months follow-up. There were 196 pregnancies within 12 months in those 376 couples underwent IVF/ICSI. Sixty one cases（couples） accepted AID or adoption. Conclusions：The diagnosis and treatment of male azoospermia infertility should follow the Chinese Medical Guideline of Male Infertility, and the invasive methods should be prudently used. It should be proposed to make the medical decision under sufficient discussion between doctors and patients. It is important to diagnose and treat reasonably azoospermia infertility in clinical practice.