经直肠联合经阴囊超声检查在获得性梗阻性无精子症中的诊断价值

目的 探讨获得性梗阻性无精子症经直肠联合经阴囊的超声特征,评价超声检查在获得性梗阻性无精子症患者定位诊断中的作用.方法 回顾性分析72例获得性梗阻性无精子症患者(病例组)的临床资料,均行经直肠超声及经阴囊超声检查,观察睾丸、附睾、阴囊段输精管、精囊、射精管、前列腺的声像图表现.并以同期60例精液检查正常者为对照,进行超声特征分析.结果 72例获得性梗阻性无精子症患者中,经直肠超声发现前列腺中线囊肿25例,射精管结石或钙化18例,慢性精囊炎13例;经阴囊超声检查发现输精管扩张43例,附睾异常团块17例,附睾局部增厚伴网状改变24例,睾丸网扩张或囊肿4例;与对照组相比,超声检查发现获得性梗阻性无精子症的远端精道病变、附睾病变异常率明显增高,差异有统计学意义(P<0.01);病例组与对照组睾丸体积比较,差异无统计学意义(P>0.05);附睾头、体、尾部的厚度与对照组比较明显增厚,差异均有统计学意义(P<0.05).结论 经直肠联合阴囊超声能够发现输精管道不同部位的病变,获得性梗阻性无精子症的远端精道病变、附睾病变异常率及附睾体积均增高,经直肠联合阴囊经超声检查能够为获得性梗阻性无精子症患者梗阻部位的定位诊断提供可靠的影像学依据.

Diagnostic value of transrectal and scrotal ultrasonography in acquired obstructive azoospermia

Objective To investigate the transrectal and scrotal ultrasonographic features of acquired obstructive azoospermia and evaluate the role of ultrasonography in the topical diagnosis of acquired obstructive azoospermia patients.Methods Seventy-two cases of acquired obstructive azoospermia in recent years were retrospectively analyzed.All patients underwent transrectal and scrotal ultrasonography.The ultrasonographic features of testis, epididymis, scrotal segment of vas deferens, seminal vesicle, ejaculatory duct and prostate were observed.Sixty cases with normal semen were taken as a control group.Results Among the 72 cases of acquired obstructive azoospermia, prostate midline cyst was found in 25 cases, stone or calcification of the ejaculation duct in 18 cases, Chronic seminal vesicle inflammation in 13 cases, abnormal mass of epididymis in 17 cases, localized thickening of epididymis with reticular change in 24 cases, and expansion or cyst of the rete testis in 4 cases.Compared to the control group, ultrasound examination increased the detection rate of distal seminal duct lesions and epididymal lesions in acquired obstructive azoospermia patients(P<0.01).Comparison of testicular volume between case group and control group did not reveal significant difference(P>0.05).The thickness of the head, body and tail of epididymis in case group was significantly bigger than that in control group(P<0.01).Conclusion Transrectal and scrotal ultrasonography can found the lesions in different parts of the seminal passage.Acquired obstructive azoospermia patients have increased rate of distal seminal duct lesions, epididymal lesions and epididymis volume.Transrectal and scrotum ultrasonography can provide reliable imaging evidence for the topical diagnosis of acquired obstructive azoospermia.