无精子症263例病因诊断分析

本文对１９８６～１９９２年门诊收治的２６０３例男子不育症中的２６３例无精子症患者进行病因诊断分析。提出无精子症病因诊断应根据病史、体检、第二性征、睾丸体积、精液分析、生殖激素等检查方法，首先区别是梗阻性的还是非梗阻性的。按ＷＨＯ男性不育诊断流程图的诊断标准对无精子症２６３例进行病因分类，提出其常见病因依次为先天异常不育８９例，特发性无精子症５５例和附属性腺感染不育４５例。对睾丸功能、阴囊探查和睾丸活检在无精子症病因诊断中的作用作了介绍。     

无精子症病人性激素测定和精液细胞学检查

目的 :对无精子症病人进行血清性激素和精液细胞学分析。　方法 :4 5例无精子症病人采用放射免疫法(RIA)检测性激素 ,瑞 吉染色法进行精液细胞学检查。　结果 :4 5例无精子症病人中 ,未检出生精细胞者 2 9例 ,血清T值降低 14例 (31 1% ) ,FSH、LH升高 13例 (2 8 9% ) ,PRL升高 4例 (8 9% )。　结论 :睾丸体积减小、T值降低、FSH和LH升高 ,提示睾丸功能损害 ,并且T/LH值更能反映睾丸间质细胞的功能 ;血清PRL只有在诊断高泌乳素血症引起的无精子症中才有意义 ;血清性激素测定和精液细胞学检查在鉴别非梗阻性与梗阻性无精子症是一项重要指标 ,对判定睾丸功能的损害程度和指导临床治疗有重要意义。     

无精子症精道造影209例分析

目的总结分析近6．5年来的输精管造影经验。方法对初步诊断为梗阻性无精子症的男性不育209例施行单人操作经皮穿刺输精管精道造影，对经皮穿刺失败者顿行开放穿刺。两侧穿刺成功后同时注射76％泛影葡胺一次摄片。结果209例中，异常50例（23．9％），其中输精管梗阻31例，射精管梗阻7例，其他异常12例。结论精道造影显影清晰直观，对梗阻性无精子症梗阻部位的确定和治疗方案的选择具有独特价值。     

无精子症263例病因诊断分析

本文对１９８６－１９９２年门诊收治的２６０３年男子不育症中的２６３例无精子症患者进行了病因诊断分析。提出无精子症病因诊断应根据病史，体检、第二性征、睾丸体积、精液分析，生殖激素检查方法，首先区别是梗阻性的性的还是非梗阻性的。     

输精管造影异常10例分析

无精子症可因生精功能的障碍引起,也可由于输精道的阻塞引起。输精道是否存在阻塞,精道造影具有重要意义。近两年来,我们对来我院就诊的105例男性不育症患者中的无精子症者作输精管造影检查40例,发现10例有输精道阻塞或先天性畸形。现报告如下。 材料与方法 本组10例,年龄23～31岁,平均26.3岁。婚龄1～5年不等,性生活正常。均无睾丸炎及附睾结核病史,2例有附睾炎史。体检:第二性征均正常,     

重视无精子症的病因诊断

无精子症指离心后精液沉淀未检出精子。通过详尽的病史收集和仔细的体格检查,临床医生可以初步判定无精子症的病因。睾丸性或睾丸前性无精子症,应进行基因和促性腺激素的检测;建议对先天性双侧输精管缺如和原发性附睾梗阻性无精子症患者,行囊性纤维化跨膜传导调节因子(CFTR)基因突变的检测,以防子代囊性纤维化的发生。卵泡刺激素和抑制素B与睾丸体积结合,有助于对睾丸的生精功能作出判断;当睾丸体积正常时,诊断性睾丸穿刺可以进一步鉴别无精子症是梗阻性还是睾丸性。输精管造影仅在精道重建手术时施行,可以确定梗阻位置,又避免损伤。     

精液生精细胞检查鉴别诊断无精子症

近年来 ,用精液生精细胞来评价睾丸生精功能 ,特别是用于鉴别诊断梗阻性与原发性无精子症的研究受到人们的关注[1,2 ] 。研究认为 ,同一病人精液生精细胞检查结果与睾丸活检所反映的细胞发育水平相一致 ,并认为是替代睾丸活检的理想方法[1] 。本文以精液细胞学结合精浆生化指标对 4 6例无精子症的发生类型和睾丸生精功能进行了观察。旨在进一步研究探讨生精细胞学检查在鉴别诊断无精子症中的意义。1　材料与方法1 1　研究对象　来我院男科门诊的无精子症不育病人 4 6例 ,均经 3次以上精液常规检查证实 ,年龄2 3～ 31岁 ,不育史 1～ 8年 ,性…     

126例无精子症病因分析和诊治体会

本文对在1993年9月～1995年12月，门诊诊治的1342例男性不育症中的126例无精子症病人进行病因诊断分析，提出无精子症的病因诊断应根据病史、体检、第二性征、睾丸体积、精液分析、生殖激素等检查方法。按传统的病因分类方法可分为睾丸原发性生精障碍41例，睾丸后病变54例，睾丸前病变10例，其它（包括精索静脉曲张和特发性无精子症）21例，并对睾丸活检、睾丸性激素测定和精索静脉曲张在无精子症病因诊断中的作用作了讨论。对126例无精子症中的64例，采用中西医结合方法进行治疗，有效率达26．56％。     

梗阻性无精子症的定位诊断及病因分析

目的探讨梗阻性无精子症的定位诊断及病因.方法回顾性分析2009年6月至2011年12月期间收治的47例梗阻性无精子症患者的临床资料,包括病史、查体、精浆生化检测、经直肠超声检查,通过手术探查最终确定的梗阻部位.结果47例梗阻性无精子症患者中,先天性双侧输精管缺如4例,精囊发育不良3例,射精管梗阻15例,双侧输精管梗阻5例,双侧附睾尾部梗阻13例,双侧附睾头部梗阻3例,附睾一侧头部对侧体部梗阻2例,附睾一侧体部对侧尾部梗阻2例.结论梗阻性无精子症的致病因素为先天发育不良及后天的炎症、创伤等,通过详细的病史采集、查体、精浆生化检测、经直肠超声检查,术前可对大部分梗阻部位作出判断.     

无精子及严重少精子症的遗传学缺陷分析

目的 探讨遗传缺陷在无精子、严重少精子症中的检测意义。方法 采用细胞遗传学技术及多重聚合酶链反应(PCR)技术对65例无精子及严重少精子症患者进行染色体核型分析、Y染色体无精子因子(AZF)检测，同时行精索输精管诊察，阴性者行精液果糖定量实验。结果 染色体核型异常8例(12．3％)，AZF因子缺失7例(10．8％)，输精管缺如2例(3.1％)。结论 遗传学检测在男性无精子、严重少精子症有重要意义。     

Relationship of azoospermia to inguinal surgery

Nearly one-third of paediatric surgery consists of operations on the inguinal canal. A late complication of this is male sterility due to damage to the vas deferens. Correction of this preventable cause is problematical and there is poor outlook for the severly oligozoospermic and azoospermic male. The true incidence of unilateral damage to the vas deferens is unknown, as this can be masked by a normal reproductive tract on the contralateral side. However, occasionally more subtle changes other than direct transection and fibrosis of the vas deferens can prevent sperm transport. This may be related to damage to the vas pseudocilia, it's auto-nomic and peptidergic innervation leading to defective contractility. This report presents four cases, which confirm the vunerability of the vas deferens during inguinal surgery and highlight azoospermia as a late complication.     

梗阻性无精子症的原因,部位与治疗分析：附51例报告

分析５１例梗阻性无精子症的原因、部位与手术治疗情况，其中先天性原因３１例（６０．８０％），感染原因６例（１１．７６％），损伤或输精管结扎原因８例（１５．６８％），不明原因６例（１１．７６％）。梗阻在附睾头部４例（７．８５％），附睾体尾部７例（１３．７２％），附睾尾部５例（９．８１％），输精管３５例（６８．６２％），无射精管梗阻者。同时对２４例拖行了手术探查或治疗，其中输精管吻合８例，术后７例女方怀     

显微外科吻合术治疗医源性腹股沟输精管梗阻

目的总结腹股沟区手术输精管损伤后的再通治疗经验。方法2005年7月至今收治11例有双侧腹股沟手术史的梗阻性无精子症患者,手术探查腹股沟区均证实输精管损伤,完全离断4例,断端以细弱瘢痕相连的7例,采用手术显微镜下精微对位多层吻合输精管再通术。结果全部病例中10例行再通手术,7例术后精液检测发现精子。结论腹股沟区手术损伤后的输精管再通手术难度较大,显微镜下精微对位多层吻合输精管再通术是治疗腹股沟区输精管损伤的首选方案。     

Does the cause of obstructive azoospermia affect the outcome of intracytoplasmic sperm injection: a meta-analysis

OBJECTIVE: To define whether the outcome of intracytoplasmic sperm injection (ICSI) using sperm surgically retrieved from men with obstructive azoospermia (OA) depends on the cause of obstruction. PATIENTS AND METHODS: We first analysed our data and then used a meta-analysis of published data (including ours) to compare the outcome of ICSI in OA, classified in terms of congenital and acquired causes. The present study comprised 82 couples who underwent 127 ICSI cycles using surgically retrieved sperm. The cause was classified as congenital bilateral absence of vas deferens (CBAVD, in 20), after vasectomy (56), infective/inflammatory (21), noninfective (24) and ejaculatory (five). Five reports (687 cycles) including the present were identified as suitable for meta-analysis. RESULTS: Analysis of the present data showed that fertilization and live-birth rates were highest in men with a previous vasectomy and no infective cause (vasectomy 51% and 23%; not infective 53% and 29%, respectively) and lowest in men with infective or inflammatory causes. There was no difference in outcome if the sperm was fresh or frozen, or whether epididymal or testicular. Meta-analysis comparing congenital (CBAVD) and acquired causes showed a significantly increased fertilization rate (95% confidence interval, 0.84-1) with acquired causes. Meta-analysis of the three papers reporting delivery outcome showed no difference in live-birth rate but a significantly higher miscarriage rate in the congenital group (relative risk 2.67). CONCLUSION: In ICSI cycles in men with OA the cause appears to influence the outcome, but outcome is not affected by whether the retrieved sperm is fresh, frozen, epididymal or testicular. The meta-analysis suggested a higher fertilization rate and lower miscarriage rate in acquired causes of OA.     

显微外科技术下梗阻性无精子症术前诊断及治疗方式探讨

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。     

Duplicated vas deferens: A case report and comprehensive review of the literature

Duplication of vas deferens is a very rare anomaly which two vasa deferentia are found in the spermatic cord. It can be recognised during autopsy or cadaveric dissection and also several surgical procedures which require spermatic cord dissection including inguinal hernia repair, orchiopexy, vasectomy, varicocelectomy, vasectomy reversal and radical prostatectomy. Recognition of the duplicated vas deferens is important to avoid surgical complications such as an unsuccessful vasectomy or transection of the vas. It was reported in only three cadavers and 31 patients since 1959. In this study, we describe a new case of duplicated vas deferens found incidentally during routine inguinal hernia repair in a 66-year-old patient. We also review all previously reported cases in the literature to draw attention to this rare but important anomaly.     

Intravasal "toothpaste" in men with obstructive azoospermia is derived from vasal epithelium, not sperm

PURPOSE: Men undergoing vasectomy reversal many years after vasectomy are at increased risk for secondary epididymal obstruction. When this occurs the intravasal fluid is often a thick, white, toothpaste-like material devoid of sperm. In this study we characterize the vasal fluid found in men with a newly described entity, segmental dysplasia of the vas deferens, in which at least 2 distinct sites of vasal obstruction are present. We determine the significance of this fluid in men with obstructive azoospermia. MATERIALS AND METHODS: Three men who underwent scrotal exploration for obstructive azoospermia due to segmental dysplasia of the vas deferens were evaluated. Each underwent scrotal exploration including bilateral vasotomy and testicular biopsy. Intravasal fluid was collected, evaluated microscopically and sent for cytopathological evaluation. RESULTS: All men had isolated segments of the vas 2 to 5 cm in length that were not connected to the epididymis or ejaculatory ducts. We have named this condition segmental dysplasia of the vas deferens. Vasotomy was performed between aplastic segments, revealing thick, white, toothpaste-like material identical to that seen in men with secondary epididymal obstruction undergoing vasectomy reversal. Cytopathological evaluation of this fluid revealed proteinaceous concretions and rare clusters of degenerated columnar epithelial cells, but no sperm or sperm products. CONCLUSIONS: Thick, white, toothpaste-like material is produced between 2 obstructed segments as seen in men with segmental dysplasia of the vas deferens and with secondary epididymal obstruction. Our findings in men with segmental dysplasia of the vas deferens indicate that vasal "toothpaste" must be derived from vasal epithelium, not sperm.     

我国输精管缺如研究趋势及文献计量分析

目的 探索国内关于输精管缺如研究的发展趋势及文献计量分析.方法 应用CiteSpace对CNKI和Web of Science(WoS)数据库中所有输精管缺如相关文献进行文献计量分析,绘制科学知识图谱并分析输精管缺如研究领域的发展概况.结果 检索到CNKI文献总数158篇,发文量最高的核心作者是周惠耕,共形成多个独立且...