摘要
目的:探讨梗阻性无精子症(OA)在显微外科技术下术前诊断及其治疗策略。方法:57例不育症患者确诊为OA并初步怀疑为附睾梗阻,行阴囊探查术观察附睾及输精管梗阻情况;术中对确定为附睾梗阻并在附睾液中找到活精子的患者施行附睾输精管端侧吻合术,同时对探查至附睾头部才发现精子或术中发现双侧附睾以远输精管梗阻、缺如的患者留取精子冷冻以备卵细胞胞质内单精子注射(ICSI);术后随访其疗效。结果:53例(92.9%,53/57)行阴囊探查术确诊为附睾水平OA,47例(82.5%,47/57)完成显微手术,10例(17.5%,10/57)术中留取精子冷冻。22例(46.8%,22/47)于显微手术后1～18个月从精液中检出活动精子;5例(10.6%,5/47)配偶自然受孕成功,6例(18.5%,6/32)留取精子行ICSI后配偶怀孕。结论:在显微外科技术日益成熟下,OA的术前诊断应尽量采取无创的手段,在手术探查中进行梗阻部位的确诊及决定治疗方式。
Objective： To investigate the diagnosis and treatment of epididymal obstructive azoospermia （OA） by microsurgery. Methods： We performed surgical scrotal exploration for 57 cases of OA whose obstruction was suspected to be in the epididymis. Those confirmed to be epididymal OA cases and with motile sperm in the epididymis underwent longitudinal-2-suture intussusceptive vasoepididymostomy （LIVES）. And for those with sperm in the epididymal head only or with bilateral obstruction or absence of the vas deferens in the distal epididymis, the sperm were collected and subjected to cryopreservation for intracytoplasmic sperm injection （ICSI）. After surgery, the patients were followed up for observation of the semen parameters and the rate of pregnancy. Results ： Of the total number of patients, 53 （92.9%） were diagnosed with epididymal OA by scrotal exploration, 47 （82.5%） underwent microsurgery, and the other 10 （ 17.5% ） received sperm cryopreservation. At 1 to 18 months after surgery, motile sperm were found in the ejaculate in 46.8% of the cases （22/47）, natural pregnancy in 10.6% （5/47）, and ICSI pregnancy in 18.5% （6/32）. Conclusion ： With the development of microsurgery, non-invasive means should be the first choice for the diagnosis of OA. And surgical exploration can be employed to determine the location of obstruction and the option for treatment.
出处
《中华男科学杂志》
CAS
CSCD
2012年第7期611-614,共4页
National Journal of Andrology
