阴囊超声用于选择梗阻性无精子症治疗方法

Scrotal ultrasonography for treatment choice of obstructive azoospermia

目的探讨阴囊超声对于选择梗阻性无精子症治疗方式的价值。方法前瞻性收集梗阻性无精子症患者93例行阴囊超声检查,观察附睾、输精管是否完整可见、有无扩张及钙化,测量扩张附睾管及输精管内径;根据后续治疗方式将其分为取精组(27例)和重建组(66例),比较2组病因及超声征象。采用ROC曲线评价超声参数用于筛选梗阻性无精子症治疗方式的临界值、敏感度、特异度、阳性预测值、阴性预测值和准确率。结果2组间附睾形态异常、输精管细小或缺失、钙化及附睾管内径差异存在统计学意义(P均<0.05),睾丸体积及输精管内径差异均无统计学意义(P均>0.05)。以附睾管内径0.55 mm为临界值筛选梗阻性无精子症治疗方式,其敏感度87.47%,特异度86.70%,阳性预测值77.82%,阴性预测值92.76%,准确率87.03%。结论阴囊超声对于选择梗阻性无精子症治疗方式具有重要临床意义。

Objective To explore the value of scrotal ultrasonography for choice of treatment of obstructive azoospermia.Methods Totally 93 obstructive azoospermia patients were prospectively collected for scrotal ultrasound to evaluate whether the epididymis and vas deferens were intact,dilated or calcified.The diameter of epididymal duct and vas deferens were measured.Then the patients were divided into sperm extraction group(n=27)or vasal reconstruction group(n=66)according to the treatment.The etiology and sonographic appearances were compared between groups.The cut-off values of ultrasonic parameters were evaluated by ROC curve,followed by the sensitivity,specificity,positive predicative value,negative predicative value and accuracy.Results There were significant differences of epididymal morphology,vas deferens dysplasia,calcification,and the diameter of epididymal duct between 2 groups(all P<0.05).Taken 0.55 mm for the cut-off value of diameter of epididymal duct,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of correctly identifying the patients suitable for sperm extraction was 87.47%,86.70%,77.82%,92.76%and 87.03%,respectively.Conclusion Scrotal ultrasonography plays an important role in guiding treatment for patients with obstructive azoospermia.