经阴囊及经直肠超声诊断无精子症病因的应用价值探讨

Application value of the scrotum and transrectal ultrasound to azoospermia etiology

目的:研究经阴囊及经直肠超声诊断无精子症病因的应用价值。方法:选取我院2012年3月至2014年3月接诊的90例无精子症患者作为研究对象,按临床诊断类型将他们分为对照组(非梗阻性无精子症患者)和观察组(梗阻性无精子症患者),各45例。两组患者均进行经阴囊、经直肠超声检查以及睾丸、附睾穿刺或活检,调查分析两组患者超声诊断的病因结果及穿刺或活检有精子的患者比例。结果:对照组患者经阴囊及经直肠超声诊断检查的病因主要为睾丸缩小、睾丸缩小并附睾囊肿、精索静脉曲张以及隐睾,而观察组患者经阴囊及经直肠超声诊断检查的病因主要包括射精管囊肿、射精管狭窄、输精管结扎术伴附睾管扩张以及慢性附睾炎、慢性附睾炎伴附睾管扩张、慢性附睾炎并附睾囊肿,并且两组患者附睾管扩张、附睾囊肿、精索静脉曲张等共同病因也有明显差异,两组病因比较具有统计学意义(P<0.05)。观察组患者行穿刺或活检后有精子的比例为97.78%,而对照组为88.89%,两组患者比较没有明显差异,无统计学意义(P>0.05)。结论:经阴囊及经直肠超声检查可对无精子症病因作出诊断和方向性提示,有助于区分梗阻性无精子症和非梗阻性无精子症。

Objectives： To study the application value of the scrotum and transrectal ultrasound to azoosper- mia etiology. Methods： 90 cases of azoospermia in our hospital from March 2012 to March 2014 were studied, and divided into the control group （non- obstructive azoospermia） and observation group （obstructive azoospermia） ac- cording to clinical diagnosis, each of 45 cases. All patients were tested by the scrotum, transrectal ultrasonography and puncture or biopsy of testicular and epididymal. The pathogen of ultrasound diagnostic and the proportion of pa- tients producing sperm after puncture or biopsy were surveyed and analyzed. Results： The pathogen causes of the scrotal and transrectal ultrasound diagnostic in the control group were mainly shrink testicles, testicular and epididy- real cysts shrink, varicocele and cryptorchidism, and those of the observation group were mainly ejaculation duct cyst, ejaculatory duct stenosis, vasectomy with epididymal duct dilatation and chronic epididymitis, epididymal duct dilatation with chronic epididymitis, chronic epididymitis and epididymal cysts. There were significant differences in the common cause of epididymal duct dilatation, epididymal cysts and varicocele between the two groups, and differ- ence in pathogen cause between the two groups was statistically significant （ P 〈 0.05 ）. The proportion of patients with sperm in the observation group after puncture or biopsy was 97.78%, while that in the control group was gs. 89%, without significant difference （P 〉0.05）. Conclusions： The scrotum and transrectal ultrasound is con- ducive to the diagnosis of azoospermia etiology with directional prompts, and to distinguishing obstructive azoosper- mia and non -obstructive azoospermia.