精囊镜技术治疗射精管梗阻性无精子症:附36例报告

Transurethral seminal vesiculoscopy for treatment of azoospermia secondary toejaculatory duct obstruction:report of 36 cases

目的探讨精囊镜技术治疗射精管梗阻性无精子症的可行性和疗效。方法回顾性分析2009年12月至2015年11月中山大学附属第三医院采用精囊镜射精管扩张技术治疗36例射精管梗阻性无精子症患者临床资料。患者年龄23～39岁，平均28岁。术前常规行精液分析、精浆果糖测定和经直肠超声检查等检查明确诊断为射精管梗阻性无精子症。36例无精症患者，精液量0．1～1．8ml，pH值6．0-7．2，精液常规和离心均未检出精子。结果单纯精囊镜扩张射精管治疗射精管梗阻23例，精囊镜技术联合射精管口切开治疗13例。手术时间12～60min，平均25min。33例获得随访，随访时间2-48个月，平均12个月，25例患者在术后1～3个月复查精液常规或离心可找到精子，其中17例精子密度和活力接近正常，7例获得妊娠。8例患者术后复查精液仍未见精子。结论精囊镜射精管扩张治疗射精管梗阻性无精子症技术可行，对于精囊镜技术经验丰富的术者，该方法是治疗射精管梗阻性无精子症安全有效的手段。

Objective To evaluate the utility of transurethral seminal vesiculoscopy with a slender ureteroscope for treatment ofazoospermia secondary to ejaculatory duct obstruction （EDO）. Methods From December 2009 to November 2015, the clinical data of 36 cases of azoospermia secondary to EDO by transurethral seminal vesiculoscopy with a 4.5 F ureteroscope were analyzed. In the 36 patients, the mean age was 28 years （range 23-39 years）. All the patients were diagnosed as azoospermia secondary to EDO. The diagnostic criteria included semen analyses, fructose in seminal plasma and transrectal ultrasonography （TRUS）. Semen analyses showed low semen volume （range 0.1-1.8 ml） and low pH （range 6.0-7.2）. Meanwhile there was no sperm found in the semen.Results Transurethral seminal vesiculoscopy by dilating purely ejaculatory duct was performed in 23 cases. The other 13 cases were treated with transurethral seminal vesiculoscopy associated with transurethral resection of ejaculatory duct （TURED）. The mean operative time was 25 min （range 12-60 min）. There were no complications including injury of urethra and rectum and postoperative discomforts related to transurethral seminal vesiculoscopy. In those 36 cases, 3 patients were out of follow-up. The mean follow-up time was 12 months （range 2-48 months）. Sperm was detected in 25 cases within 1 to 3 months after performing transurethral seminal vesiculoscopy. Seven patients＇ spouses were fortunately pregnant. Conclusions Transurethral seminal vesiculoscopy by using slender ureteroscopy could be an effective and feasible option for the treatment of azoospermia secondary to EDO with few.