80例輸精管道梗阻性無精子癥的臨床診斷及治療

丁智勇 張大虎 陳懷波 李忠遠 石濤 周本正 毛飛 凡磊

【摘要】目的：探討輸精管道梗阻性無精子癥臨床診治情況，以期提高臨床療效。方法：選取2011年1月至2013年1月80例輸精管道梗阻性無精子癥患者為研究對象，從病因、臨床表現(xiàn)、輔助檢查和治療等進行總結。結果：80例輸精管道梗阻性無精子癥病因中先天性占21例、后天性占55例、特異性因素4例，平均性成熟年齡為（17.3±3.4）歲，毛發(fā)和皮下脂肪異常多見，睪丸多可觸及不同程度硬結和疼痛感，平均精液量為（1.5±1.1）mL，pH值為（7.9±1.6），粘稠度呈米湯樣31例，41例出現(xiàn)不液化情況，遺傳學檢查中b、c亞區(qū)缺失31例。80例患者陰囊探查見遠睪輸精管和射精管均通暢，其中49例在附睪切口溢液找到活精子，21例附睪尾部找到活精子，5例在附睪體部找到活精子，5例在附睪頭部找到活精子，術后多數(shù)在6個月內(nèi)出現(xiàn)活精子，精子數(shù)量（2～70）×109/L，精子活率（10～60）%，精子活力為Ⅰ～Ⅲ級，其中49例患者在治療后6個月內(nèi)配偶妊娠，29例12個月內(nèi)出現(xiàn)妊娠，治療后精液量、果糖、中性α葡糖苷糖較治療前明顯提高，治療前后比較差異顯著（P<0.05）。結論：輸精管道梗阻性無精子癥臨床診斷明確，經(jīng)手術治療后療效滿意。

【關鍵詞】輸精管道梗阻性無精子癥；臨床診治

【Abstract】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） × 109 / 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.

【Key words】Vas deferens obstruction azoospermia； Clinical diagnosis and treatment

【中圖分類號】R698+.2【文獻標志碼】A

輸精管道梗阻性無精子癥占無精子癥的40%左右，在臨床上可分成先天性、獲得性和特發(fā)性3種類型，其中先天性雙側輸精管缺如是常見先天因素，感染、外傷和醫(yī)源性是常見獲得性因素，而特發(fā)性因素則很多。近些年隨著顯微外科手術進步，既往睪丸穿刺或活檢方法獲得精子后再進行輔助生殖技術已經(jīng)被替代，患者也希望通過顯微技術獲得自然妊娠?！?br>