经体表超声检查在获得性梗阻性无精子症中的应用及其附睾与输精管声像改变分析

Analyze the application of superficial ultrasound examination and imaging changes of epididymis and deferent duct in acquired obstructive azoospermia patients

目的:分析经体表超声检查在获得性梗阻性无精子症中的应用及其附睾与输精管声像改变,以期为后续治疗提供依据。方法:收集2016年1月—2019年3月间我院收治的62例近段输精管道获得性梗阻性无精子症患者作为此次研究对象,纳入观察组,另选取同期来院行精液检查正常的60名体检者,纳入对照组,分析两组睾丸、附睾及阴囊段输精管的超声声像图。结果:两组睾丸体积对比差异无统计学意义(P>0.05),但观察组附睾头、附睾体以及附睾尾厚度均高于对照组,差异有统计学意义(P<0.05),在112条无手术史的附睾炎性梗阻的输精管中,110条(98.2%)的内径为(0.04±0.02)cm,与对照组相同,扩张仅2条(1.8%),内径0.13cm、0.14cm,经直肠超声检查未见输精管壶腹明显扩张;12条有手术史者,近端输精管扩张。获得性近段输精管道梗阻62例,附睾124条,包括炎性梗阻56例,手术致梗阻6例。在附睾头部中,输出小管扩张占66.13%,回声杂乱占8.87%,在附睾体部和尾部均以附睾管扩张为主,分别达到79.84%和61.29%。结论:获得性梗阻性无精子症由于梗阻的原因和部位不同,附睾与输精管的声像图改变具有不同的特征,应用经体表超声检查可为近段输精管道获得性梗阻性无精子症的诊断提供可靠的影像学依据。

Objective To analyze the application of superficial ultrasound examination and imaging changes of epididymis and deferent duct,and provide basis on the subsequent therapy for acquired obstructive azoospermia patients.Methods The clinical data about 62 patients with acquired obstructive azoospermia of proximal deferent duct(2016.12019.3)were selected as observation group;60 check-ups with normal semen examination results were selected as control group.The imaging changes of testis,epididymis and scrotal deferent duct were analyzed.Results:The testis volume between groups showed no statistically significant difference(P>0.05);The thickness of epididymis head,body and tail in the observation group was significantly larger than control group(P<0.05);For 112 inflammatory obstruction deferent ducts without operation history,110 ducts had inner diameter of(0.04±0.02)cm(98.2%),which were just the same as those in the control group.Only two dilated ducts were found with inner diameter of 0.13cm and 0.14 cm(1.8%).The transrectal ultrasound examination showed no obvious dilation of deferent duct ampulla.12 ducts with operation history had proximal deferent duct dilation.For 62 acquired obstructive azoospermia cases of having 124 epididymis,there were 56 inflammatory obstruction cases and 6 surgical obstruction cases.In the epididymis head,the ratio of having efferent duct dilation was 66.13%and mull echo at 8.87%;In the epididymis body and tail,the ratio of epididymis duct dilation was 79.84%and 61.29%,respectively.Conclusion Owing to the changed obstruction causes and positions,the diverse imaging characteristics of epididymis and deferent duct are presented.In addition,the superficial ultrasound examination can provide the reliable basis for diagnosing the acquired obstructive azoospermia of proximal deferent duct.