80例输精管道梗阻性无精子症的临床诊断及治疗

Diagnosis and treatment for 80 patients with obstruction of vas deferens azoospermia

目的：探讨输精管道梗阻性无精子症临床诊治情况,以期提高临床疗效。方法：选取2011年1月至2013年1月80例输精管道梗阻性无精子症患者为研究对象,从病因、临床表现、辅助检查和治疗等进行总结。结果：80例输精管道梗阻性无精子症病因中先天性占21例、后天性占55例、特异性因素4例,平均性成熟年龄为（17.3±3.4）岁,毛发和皮下脂肪异常多见,睾丸多可触及不同程度硬结和疼痛感,平均精液量为（1.5±1.1）mL,pH值为（7.9±1.6）,粘稠度呈米汤样31例,41例出现不液化情况,遗传学检查中b、c亚区缺失31例。80例患者阴囊探查见远睾输精管和射精管均通畅,其中49例在附睾切口溢液找到活精子,21例附睾尾部找到活精子,5例在附睾体部找到活精子,5例在附睾头部找到活精子,术后多数在6个月内出现活精子,精子数量（2～70）×10^9/L,精子活率（10～60）%,精子活力为Ⅰ～Ⅲ级,其中49例患者在治疗后6个月内配偶妊娠,29例12个月内出现妊娠,治疗后精液量、果糖、中性α葡糖苷糖较治疗前明显提高,治疗前后比较差异显著（P〈0.05）。结论：输精管道梗阻性无精子症临床诊断明确,经手术治疗后疗效满意。

Objectives： To investigate the situation of clinical diagnosis and treatment of vas deferens obstruction azoospermia, so as to improve clinical efficacy. Methods ： 80 patents with obstruction of the vas deferens azoospermia from January 2011 to January 2013 were selected in this study to summarize the etiology, clinical manifestations, laboratory examination and treatment. Results： Among the 80 cases of obstruction of the vas deferens azoospermia, there were 21 cases of congenital and 55 cases of posteriority. The average age of sexual maturity was （17.3 ±3.4） years. Hair and subcutaneous fat abnormalities were more common. Testis was more often with different degrees of induration and pain. The average semen volume was （ 1.5 ±1.1 ） ml, PH value （7.9 ±1.6）. In the aspect of viscosity, there were 31 cases with rice soup semen and 41 cases with no liquefaction semen. Genetic testing showed that there were 31 cases missing b, c Asia District. 80 patients scrotal exploration showed far testis vas deferens and ejaculatory ducts were unobstructed, in which 49 cases were found live sperm in the epididymis cut discharge, 21 cases were found live sperm at the cauda of testis, 5 cases were found live sperm in the epididymis body, and 5 cases were found live sperm in the epididymal head. The live sperm of the majority appeared six months after surgery; the number of sperm was （2 -70） ×10^9/ L; sperm motility was （10 -60）% ; sperm motility was Ⅰ-Ⅲ grade. 6 months after treatment, 49 cases＇ spouses were pregnant. 12 months after the treatment, 29 cases＇ spouses were pregnant. After treatment, semen volume, fructose and neutral α - glucosidase sugar were significantly improved, with significant difference （P 〈 0. 05）. Conclusion ： The vas deferens obstruction azoospermia is clinically diagnosed, with satisfactory results after treatment.