11例附睾梗阻性无精子症患者附睾病理特征

目的:观察继发于感染的双侧附睾梗阻性无精子症患者的附睾病理特征,分析可能的病理生理机制以便寻找可能的治疗靶点。方法:2015年3~12月,收集既往有附睾感染史的不育就诊者11例,年龄28~53岁。通过精液常规、精液离心检查筛选确诊为无精子症患者,行生殖激素、精浆生化、阴囊超声检查,初步确定系附睾梗阻性无精子症者,进行手术探查,观察附睾大体病理特征并采集图像;切取病变处附睾组织,行病理切片观察。结果:病变附睾大体标本观察示,附睾管积水样改变是主要的病理特征;病理切片观察,附睾管管腔结构完整,管腔内充盈扩张,腔内未见精子。大多数病例管壁间未见炎性细胞浸润,以无纤维化为主。少数病程较长患者除附睾管扩张外,可见腔内组织细胞浸润、间质纤维组织增生或间质纤维透明变性,散在淋巴细胞、嗜酸性细胞浸润。结论:继发于感染的附睾梗阻性无精子症患者病变附睾的病理解剖学特征主要为附睾管积水,以及造成的腔内梗阻,其具体机制有待进一步研究。     

附睾输精管吻合术治疗梗阻性无精子症

目的探讨附睾输精管吻合术在梗阻性无精子症治疗中的作用。方法选择23例确诊为梗阻性无精子症并初步怀疑为附睾水平梗阻的患者进行阴囊探查，观察睾丸、附睾及输精管情况，对其中19例确定为附睾水平梗阻并在附睾液中找到活精子的患者用8-0尼龙线施行双侧或单侧附睾输精管端侧吻合术，术后随访其疗效。结果19例获随访8～34个月，9例(47％)于术后3～9个月从精液中检出活精子，其中5例配偶受孕成功。结论阴囊探查简单、易行，有助于梗阻性无精子症的诊断和治疗，附睾输精管吻合术治疗梗阻性无精子症取得初步效果，值得进一步探讨。     

附睾梗阻性无精子症的手术治疗

目的 评价附睾梗阻性无精子症(EOA)的手术效果和影响因素. 方法回顾性分析51例EOA患者的临床资料.患者均在硬膜外麻醉下行阴囊探查术.放大镜辅助下,行单层纵向2针套叠式输精管附睾吻合术(LIVE).收集资料包括手术方法、随访时间、术后精子数平均值、a级精子百分率及复通率和受孕率. 结果 平均手术时间(134±36)min.49例一侧或双侧附睾有精子检出,其中1例一侧附睾对侧输精管检出精子;2例附睾未检出精子.49例附睾找到精子者中,48例行单侧或双侧LIVE,1例行单侧LIVE对侧输精管端端吻合.48例行单纯LIVE者失访4例,余44例随访7～17个月,32例精液中检出精子,复通率为72.7%;精子总数平均为(24±23)×106个;28例(87.5%)精液中检出a级精子,a级精子平均为(12.0±11.2)%.39例随访12个月,其中10例妊娠,受孕率为25.6%.术后妊娠与吻合口位置有关,本组妊娠均为吻合部位在尾部者. 结论 放大镜辅助下的LIVE操作简单、费用低,并能取得满意的复通率和受孕率;术中应考虑吻合口位置对妊娠的影响.     

梗阻性无精子症附睾超声声像图特征研究

目的:探讨先天性及后天获得性梗阻性无精子症附睾超声声像图的特征性改变。方法:应用经阴囊超声观察和评估211例梗阻性无精子症患者附睾的异常声像图改变,比较先天性(n=118)及后天获得性梗阻性无精子症(n=93)附睾超声声像图特征的差异。结果:先天性梗阻性无精子症附睾头部回声杂乱伴输出小管扩张、体尾部缺如、体尾部条索样改变、体尾部截断征百分率高于后天获得性梗阻性无精子症,差异有统计学意义(P<0.05)。后天获得性梗阻性无精子症附睾体尾部附睾管细网状扩张、附睾尾炎性团块百分率高于先天性梗阻性无精子症,两者差异有统计学意义(P<0.01)。先天性梗阻性无精子症附睾头、体、尾附睾管状扩张百分率分别为:5.9%(14/236)、17.2%(41/236)、8.4%(20/236),高于后天获得性梗阻性无精子症(P<0.05),后天获得性梗阻性无精子症附睾头、体、尾附睾管细网状扩张的百分率分别为:64.0%(119/186)、76.3%(142/186)、58.6%(109/186),高于先天性梗阻性无精子症(P<0.05)。先天性梗阻性无精子症附睾主要特征为附睾管不规则扩张伴管壁回声减弱且结构欠清(P<0.05),后天性梗阻性无精子症附睾管则呈规则扩张伴管壁回声增强(P<0.01)。结论:先天性及后天获得性梗阻性无精子症附睾超声声像图特征存在明显不同,对于两者鉴别有很大的临床实用价值。     

输精管转位附睾吻合术治疗特殊梗阻性无精子症

目的 探讨应用显微外科技术施行输精管转位附睾端侧吻合术在特殊梗阻性无精子症治疗中的作用.方法 对梗阻性无精于症患者施行阴囊探查术,术中行精路通液试验确诊为特殊梗阻性无精子症14例,即一侧附睾梗阻或发育异常未检出精子而输精管通畅,对侧附睾检出活精子但输精管梗阻或发育异常.应用显微外科技术行输精管转位附睾吻合术,健侧输精管与对侧附睾检出活精子处吻合,术后随访其疗效. 结果 14例获随访7～31个月,9例于术后3～9个月从精液中检出活精子,复通率64%,5例配偶受孕成功,致孕率36%. 结论 显微外科输精管转位附睾吻合术治疗这种特殊梗阻性无精子症效果良好,值得临床推广.     

输精管附睾显微吻合术治疗梗阻性无精子症疗效分析

目的 探讨纵向2针套叠式输精管附睾显微吻合术治疗梗阻性无精子症的手术疗效.方法 对确诊为附睾水平梗阻的梗阻性无精子症25例施行纵向2针套叠式输精管附睾显微吻合术,术后随访复通率、配偶妊娠率.结果 术后随访25例,复通21例(84%);配偶妊娠17例(68%).结论 纵向2针套叠式输精管附睾显微吻合术治疗梗阻性无精子症是一种手术操作相对简便、疗效显著的外科技术.     

交叉输精管附睾显微吻合术治疗复杂梗阻性无精子症

正在男性不育患者中,无精子症的发病率约占10%~15%,其中梗阻性无精子症(obstructive azoospermia,OA)约占40%[1]。显微外科输精管吻合术、输精管附睾吻合术因其显著优势而成为近年来梗阻性无精子症的首选治疗[2]。然而有些复杂梗阻性无精子症,如单侧睾丸发育不良而对侧输精管缺如或多段梗阻,无法通过常规的同侧输精管或输精管附睾显微吻合术治疗,而施行交叉吻合可以     

抽取附睾精子作人工受精治疗梗阻性无精子症初步报告

本文从５例梗阻性无精子症不育患者输精和收集附睾精子。其中除１例为附睾先天性梗阻，作附睾－输精管吻俣术外，余均为远端输精管不通畅或缺如。第二性症发育良好，性激素，睾丸容积等均正常。抽吸附睾液放入术前精浆和精子保养液中冷冻保存，解决复苏后４例行人工授精。     

梗阻性无精子症患者附睾精子染色体非整倍体和二倍体率均增高

单精子卵胞浆内注射已用来治疗严重的男性不育患者,对于梗阻性无精子症患者可以用附睾和睾丸的精子。为了评估梗阻性无精子症患者睾丸、附睾中非整倍体和二倍体精子率以及其对单精子注射结果的影响,作者对24例梗阻性无精子男性和24     

显微技术附睾管输精管吻合治疗梗阻性无精子症

目的　探讨附睾管梗阻性无精子症的有效治疗方法。方法　我科自2001年12月～2006年12月应用显微外科技术对9例附睾管梗阻性无精子症患者行附睾管输精管吻合术进行回顾性分析。结果　7例术后精液分析可见精子,其中5例精液分析结果正常,2例已生育。手术成功率77．8％。结论　应用显微外科技术行附睾管输精管吻合术是目前治疗附睾管梗阻性无精子症的有效方法。     

左旋肉碱在经皮附睾穿刺取精-卵细胞胞质内单精子注射治疗中的应用

目的:探讨左旋肉碱在经皮附睾穿刺取精-卵细胞胞质内单精子注射(PESA-ICSI)治疗中的应用。方法:随机将2008年9月至2009年8月间本中心就治的79例梗阻性无精子症患者分成2组:未服药组(A组36例)和服药组(B组43例)。B组ICSI治疗取卵前3个月口服左旋肉碱(1g,2次/d)治疗,A组未作任何治疗作为对照,比较A、B两组间PESA-ICSI的获卵数、受精数、受精率、优质胚胎数和优质胚胎率。结果:A、B两组间受精数和受精率无显著性差异,但B组获得优质胚胎数及优质胚胎率明显高于A组(P<0.05)。结论:ICSI治疗前不育男性口服左旋肉碱3个月能显著提高PESA-ICSI的优质胚胎数及优质胚胎率,为将来获得良好的妊娠结局奠定基础。     

The value of epididymal protease inhibitor in differential diagnosis between obstructive azoospermia and non-obstructive azoospermia

There are no efficient and noninvasive clinical tests to distinguish between obstructive azoospermia (OA) and non-obstructive azoospermia (NOA). Epididymal protease inhibitor (Eppin) protein is secreted specifically by testes and epididymides in male reproductive system. It does not exist in seminal plasma of patients with OA in theory. The seminal plasma from 40 normal men and 46 azoospermic patients was detected via Western blot for investigating the presence and characteristics of Eppin protein to distinguish between OA and NOA. The cases were diagnosed as NOA whether Eppin in seminal plasma was positive via Western blot analysis. The cases were diagnosed as OA when samples were Eppin-negative. Additionally, percutaneous epididymal sperm aspiration (PESA) and percutaneous testicular sperm aspiration (PTSA) were performed on these patients at the same time as the diagnostic criteria to compare with Western blot analysis. Eppin detection in seminal plasma showed similar effectivity with PESA/PTSA in differential diagnosis between OA and NOA. Compared with PESA/PTSA, Eppin detection is a new, efficient and noninvasive method which has good clinical application.     

Can inhibin-B predict the outcome of microsurgical epididymal sperm aspiration in patients with suspected primary obstructive azoospermia？

Aim： To evaluate whether inhibin-B can predict the outcome of a microsurgical epidymal sperm aspiration （MESA） procedure in patients with suspected primary obstructive azoospermia （OA） and if inhibin-B can replace testicular biopsy in the diagnostic work-up of these patients. Methods： Inhibin-B levels and testicular biopsy scores were related to the outcome of MESA in 43 patients with suspected primary OA. MESA was considered to be successful when epididymal sperm could be identified during the procedure. Results： Spermatozoa were present in the epididymal aspirate in 28 out of the 43 patients （65%）. lnhibin-B values were not significantly different in patients with successful or unsuccessful MESA. The modified Johnsen score, however, was significantly lower in patients with unsuccessful MESA （P = 0.003）. A rete testis obstruction or epididymal malfunctioning was found in 15% of patients with suspected primary OA, reflected by unsuccessful MESA despite normal inhibin-B levels and normal testicular histology. Conclusion： Inhibin-B cannot replace testicular biopsy as a diagnostic tool in the work-up of patients with suspected primary OA. Testicular biopsy is useful in identifying patients with spermatogenic arrest, who might have normal inhibin-B values.     

单精子卵细胞质内注射治疗梗阻性无精子症

目的:总结单精子卵细胞质内注射治疗梗阻性无精子症的诊疗经验。方法:回顾总结2006年1月～2008年12月间107例梗阻性无精子症病例ICSI助孕资料,比较先天性输精管缺如组与非先天性输精管缺如组之间受精率、卵裂率以及妊娠率的差异。结果:107例梗阻性无精子症病例ICSI助孕中共行单精子卵细胞质内注射949枚卵子,形成受精卵678枚(受精率71.4%),获得胚胎卵裂605枚(卵裂率89.2%),临床妊娠44例,临床妊娠率41.1%。其中先天性输精管缺如49例,行单精子卵细胞质内注射442枚卵子,形成受精卵308枚(受精率69.6%),获得胚胎卵裂279枚(卵裂率90.6%),临床妊娠27例,临床妊娠率55.1%;炎症或手术等原因引起的梗阻性无精子症58例,行单精子卵细胞质内注射507枚卵子,形成受精卵370枚(受精率72.9%),获得胚胎卵裂326枚(卵裂率88.1%),临床妊娠17例,临床妊娠率29.3%。两组比较受精率、卵裂率无统计学差异(P>0.05),临床妊娠率有统计学差异(P<0.01)。结论:采用经皮附睾或睾丸穿刺抽吸精子结合ICSI技术助孕是治疗梗阻性无精子症的安全有效方法。先天性输精管缺如较其它原因所导致的梗阻性无精子症有更高的临床妊娠率。炎症或手术等原因除引起精道梗阻外也可能影响精子的质量,导致胚胎发育潜能下降。     

Clinical study of azoospermia

This study evaluated how many patients with azoospermia might have fertility potential using assisted conception techniques. A total of 102 male patients with aioospermia were included in the study. Thirteen patients had sex chromosomal abnormalities. Testicular biopsy performed in the other 89 patients showed incomplete spermatogenesis in 47 of them whereas 42 had complete spermatogenesis. In the latter 42 patients, distal vasography demonstrated bilateral obstruction of the excurrent ducts in 14 patients whereas no distal obstruction of the ducts was found in 28. The 89 patients were divided into three groups according to the findings of testicular biopsy and distal vasography. In the 14 patients with both complete spermatogenesis and distal obstruction of the excurrent ducts, surgical procedures are applicable. The pathogenesis of the 28 patients with complete spermatogenesis but without distal obstruction of the ducts should be clarified for further treatment.     

Vasal vessel-sparing microsurgical single-armed vasoepididymostomy to epididymal obstructive azoospermia: A retrospective control study

This study aimed to evaluate the efficacy and safety of vasal vessel-sparing modified single-armed 2-suture longitudinal intussusception vasoepididymostomy (SA-LIVE) to epididymal obstructive azoospermia patients. Forty consecutive epididymal obstructive azoospermia cases, who underwent microsurgical vasoepididymostomy in Shanghai General Hospital from January 2019 to October 2019, were included in this study. Twenty cases underwent SA-LIVE (group A), and 20 cases underwent vasal vessel-sparing SA-LIVE (group B). Until March 2021, the mean follow-up period was 16.9 ± 4.1 (12–23) months. The overall patency rate was 82.5%, and 80% and 85% for group A and group B respectively. The mean time to achieve patency was 4.11 ± 2.74 months. The overall natural pregnancy rate was 51.5%(17/33) at the mean follow-up of 16.9 months. The natural pregnancy rate was 50.0% for group A and 52.9% for group B (p > .05). At the time of 6 months post-operation, the patency rate was 70% for group A and 80% for group B (p = .465); the natural pregnancy rate was 0% for group A and 31.3% for group B (p = .022). Vasal vessel-sparing SA-LIVE is safe and effective to achieve favourable patency and pregnancy rates. Preserving vasal vessel would improve natural pregnancy rate at a very early stage.     

Intracytoplasmic sperm injection using surgically retrieved epididymal and testicular spermatozoa in cases of obstructive and non-obstructive azoospermia

This was a retrospective study of 115 patients who underwent 124 cycles of ICSI using surgically retrieved spermatozoa. The objective was to compare the results of ICSI in patients with obstructive azoospermia using epididymal spermatozoa (36 cycles) or testicular spermatozoa (58 cycles) with ICSI in patients with non-obstructive azoospermia using testicular spermatozoa (30 cycles). When epididymal spermatozoa were used for ICSI, the fertilization rate per injected metaphase-II oocyte and the clinical pregnancy rate per ICSI cycle were 60.4 and 25%, respectively. When testicular spermatozoa were used in obstructive cases, the fertilization rate and pregnancy rate were 57.9 and 34.5%. In non-obstructive cases the fertilization and pregnancy rates were 41.2 and 16.6%. When patients with obstructive azoospermia were regrouped according to the cause of obstruction, the fertilization and pregnancy rates were 59.1 and 35.1% in acquired obstruction and 58.7 and 24.3% in congenital obstruction. The fertilization and pregnancy rates were not statistically different ( p  > 0.05) when testicular or epididymal spermatozoa were used in obstructive cases; neither was statistically different ( p  > 0.05) when compared in patients with congenital and acquired obstruction. On the other hand, the fertilization and pregnancy rates in cases with non-obstructive azoospermia were significantly lower ( p  < 0.05) than in obstructive cases.     

Clinical observation of loupe-assisted intussusception vasoepididymostomy in the treatment of obstructive azoospermia (analysis of 49 case reports)

To evaluate the clinical outcomes of loupe-assisted intussusception vasoepididymostomy (VE) in the treatment of epididymal obstructive azoospermia (EOA), we retrospectively analyzed data from 49 patients with EOA who underwent two-suture longitudinal intussusception vasoepididymostomy (LIVE) between 2000 and 2007. The data included the surgical method, postoperative motile sperm count per ejaculation, percentage of progressive motile sperm and patency and pregnancy outcomes. There were a total of 49 men undergoing scrotal exploration, and epididymal obstruction was found in all cases. Bilateral or unilateral anastomoses were performed in 40 and 6 men, respectively. The postoperative courses of 42 patients were followed up for more than 6 months, and the courses of 38 patients were followed up for more than 1 year. The overall patency and pregnancy rates were 71.4% and 26.3%, respectively. Moreover, progressive motile sperm was more frequently present in those patients who had undergone anastomosis at cauda than at corpus or caput. Pregnancy was achieved only in those patients who had undergone anastomosis at least on one side of the cauda epididymis. We think that the loupe-assisted method, with a lower overall cost and a simplified surgical procedure, can achieve satisfactory patency outcomes and pregnancy results. Data from this paper also suggest that paternity outcomes occur more frequently after anastomoses at cauda than at corpus or caput.