双侧斜疝术后输精管道损伤相关梗阻性无精子症的手术策略分析

目的探讨双侧斜疝术后输精管道损伤相关梗阻性无精子症的手术策略。方法回顾性分析59例有双侧斜疝手术史的梗阻性无精子症患者的临床资料。结果根据术中探查情况行显微输精管吻合术、腹腔镜辅助的显微输精管吻合术、显微输精管附睾吻合术、交叉输精管吻合术。术中探查证实输精管损伤,伴或不伴附睾梗阻,14例无法行吻合手术,行取精手术;45例行显微重建手术,其中输精管吻合术30例,腹腔镜辅助的输精管吻合术12例,交叉输精管吻合术2例,右侧输精管附睾吻合术加左侧输精管吻合术1例。80.0%(36/45)的患者术后精液检查测到精子,31.1%(14/45)的患者术后自然妊娠。结论双侧斜疝术后输精管损伤相关梗阻性无精子症,损伤情况多样化,手术是有效的治疗方法,可根据个体情况选择合适的治疗的方式。     

先天性输精管缺如患者的临床与遗传特点:附41例报道

目的探讨先天性输精管缺如(CAVD)者的临床特点,分析囊性纤维跨膜转运调节因子(CFTR)国内外已知高频突变位点5T剪接变体(IVS8-5T)和F508位点遗传突变特征,旨在建立CAVD的诊治策略。方法收集41例CAVD病例临床资料,总结其分型、诊断和治疗特点,从21例患者血样中提取基因组DNA,利用聚合酶链反应(PCR)扩增5T和F508位点片段,并直接测序。结果 41例患者中20例双侧缺如患者,14例节段性缺如,7例单侧缺如。40例患者通过外科取精方式获取精子,1例取精失败患者睾丸组织病理为生精阻滞,总体取精成功率约97.6%(40/41);4例单侧缺如患者要求行对侧输精管-附睾吻合术或交叉吻合术,术后随访精液1~6个月无精子;12例取精后行卵胞质内单精子注射(ICSI),7例成功生育,2例正常妊娠中(4~8个月)。21例测序显示9例存在5T位点突变(42.9%),未见F508位点突变。结论 CAVD需综合查体、检验和超声等影像资料诊断;取精结合ICSI的辅助生殖技术(ART)是CAVD有效的治疗手段;汉族CAVD患者近半数存在5T剪接变体突变,未见白人高加索人存在的ΔF508del突变。     

输卵管显微吻合术281例临床分析

目的:探讨提高输卵管吻合复通率的可行方法。方法:采用显微外科技术对281例施行输卵管吻合术,并随访观察1-18年。结果:281例施行输卵管显微吻合术后,通畅率达100%,子宫内妊娠263例(94%)。结论:使用显微手术器械,熟练显微操作,对吻合术复通成功率有较明显的提高。     

输卵管吻合术42例临床分析

目的:分析输卵管吻合术的方法、效果及临床价值。方法:选择我院2008年1月-2009年6月42例精卵管结扎术后或输卵管异位妊娠行保守性手术处理后输卵管断裂的患者,因生育需要而要求复通,其中20例采用直视下行开腹输卵管吻合术,22例患者采用腹腔镜下行输卵管吻合术,术后随访6—24个月,观察二组患者术后妊娠结果。结果:二组患者术后均随访6—24个月,妊娠情况分别为开腹组6、12、18、24个月妊娠率分别为30%、40%、60%、75%;腹腔镜组6、12、18、24个月妊娠率分别为31.82%、40.91%、63.64%、81.82%,腹腔镜组妊娠率略高于开腹组,二种手术方法妊娠率差异无显著性,无统计学意义P>0.05。结论:输卵管吻合术是输卵管再通的有效方法。开腹手术与腹腔镜下输卵管吻合术均有较上的妊娠效果,但腹腔镜优势明显,是输卵管堵塞患者首选。     

经阴囊及经直肠超声对诊断先天性双侧输精管缺如价值的研究

目的:探讨超声检查在诊断先天性双侧输精管缺如(CBAVD)中的价值。方法:回顾性分析380例CBAVD经阴囊及经直肠超声声像图表现。结果:所有患者超声检查均出现异常声像图;其中376例的752只附睾出现超声声像图异常,异常比率为99%(752/760),包括附睾头回声杂乱伴扩张、附睾头单纯扩张、附睾体附睾管扩张、附睾体部缺失、附睾体截断征、附睾尾附睾管扩张、附睾尾部缺失;365例的706条输精管阴囊段出现声像图异常,异常比率为93%(706/760),包括双侧缺失、双侧截断征、双侧纤细、一侧正常对侧缺失、一侧截断征对侧缺失;335例患者的605条输精管末段声像图出现异常,异常比率为80%(605/760),包括双侧缺失、一侧正常对侧缺失、一侧截断征对侧缺失。369例726只精囊声像图异常,异常比率为96%(726/760),包括双侧缺失、一侧正常对侧缺失;一侧发育不良对侧缺失、双侧扩张、一侧精囊部位畸形结构对侧缺失。结论:经阴囊及直肠超声检查,可清楚显示CBAVD患者输精管道的各种发育异常结构,为CBAVD患者的临床诊治提供可靠的超声影像依据。     

腹腔镜下输卵管吻合术可行性的临床研究

目的:探讨腹腔镜下输卵管吻合术的优势及技巧。方法:回顾分析18例(1例不符合复通标准)双侧输卵管结扎术后输卵管复通吻合的临床效果,其中9例为开腹手术(TA),8例为腹腔镜手术(LA)。比较两组患者的术中失血量、手术时间、术后肠蠕动恢复时间、术后2个月输卵管通液情况、术后1年内妊娠率等。结果:腹腔镜手术的手术时间长于开腹手术[(160.8±12.3)min vs(63.1±21.5)min],术后肠管恢复时间短于开腹手术[(7.2±2.5)h vs(12.1±5.3)h,P0.05]。两组患者的术中失血量、术后输卵管复通率及术后1年内妊娠率比较,差异均无统计学意义(P0.05)。结论:在熟练手术技巧的前提下,在腹腔镜下行输卵管复通吻合术完全可行,而且利于患者早期恢复、早期妊娠。输卵管通液术及举宫器的应用将对手术的完成有一定的帮助。     

输精管结扎与吻合后人精浆L－肉毒碱果糖含量及α－1、4糖苷酶活力研究

本文报道了６３例接受显微外科输精管吻合术患者术前和４８例术后１～１２个月精浆α－１、４糖苷酶活力，Ｌ－肉毒碱和果糖含量的结果，并以４７例正常生育男子作对照研究。输精管结扎后男子精浆α－１、４糖苷酶活力与Ｌ－肉毒碱合量明显低于对照组。在吻合术后随访期间，约２／３男子输精管复通良好，精子密度（　），精浆α－１、４糖苷酶活力（４２．３６±３１ｍＩＵ／ｍｌ）和Ｌ－肉毒碱含量（４７１．８５±１９４．７１ｎｍｏｌ／ｍｌ）均达正常水平。１／３男子精浆α－１、４糖苷酶活力、Ｌ－肉毒碱含量无明显增高，同时表现出少精子（５．３±４．２×１０６／ｍｌ）与无精子。     

腹腔镜下输卵管吻合术的临床应用探讨

目的:评价腹腔镜下输卵管吻合术的临床应用价值.方法:对15例输卵管绝育术后或输卵管妊娠行保守性手术处理后输卵管断裂,因生育需要而要求复通者进行输卵管对端吻合术并随访妊娠率.结果:14例术后第1次月经干净后输卵管通液均显示通畅,术后1年半内复孕8例,受孕率57.1%.结论:腹腔镜下输卵管吻合术较开腹有一定优势,亦具有较高成功率,是输卵管堵塞患者的一个较好的治疗选择.     

经皮穿刺精液冷冻保存标本和精子胞浆内注射

对丈夫患有不可逆阻塞性无精症的夫妇 ,采用显微手术抽吸附睾精子 (MESA)联合胞浆内注射精子 (ICSI)的方法使妊娠率提高。经皮抽吸附睾精子 (PESA)比 MESA好 ,手术时间短 ,并发症少 ,方法简便。作者报道采用 PESA和冷冻保存精子 ,经冻融后行 ICSI的 2例妊娠。例 1丈夫 (4 0岁 )于 5年前行输精管切除术 ,4年前再婚后行输精管再通术 ,但术后精液分析为无精。体检睾丸正常大小 ,可触及附睾和输精管。血清 FSH、L H、T、PRL 在正常范围。重复精液检查为无精。妻 30岁 ,月经正常 ,子宫输卵管造影示输卵管通畅、宫腔正常。诊断性 PE…     

再次输卵管吻合术的可行性研究

再次输卵管吻合术是对第 1、2次吻合术后输卵管仍不通的患者施行的手术。本研究对 1991年至 1998年在我院检查及手术治疗的 42例患者进行回顾分析 ,总结如下。一、资料与方法1 研究对象 :为 42例在我院行再次输卵管吻合术病例。第 1、2次输卵管吻合手术在外院进行 ,2年以上未孕 ,经本院检查诊断为输卵管不通 ,迫切要求再次手术并经县级以上计划生育委员会批准 ,其中 39例为第 2次行吻合术、3例为第3次行吻合术。年龄 2 8～ 39岁 ,平均 32 .9岁。2 方法 :(1)手术方法 :于月经干净后 3～ 7ｄ进行 ,采用硬膜外麻醉。常规开腹后探查盆腔、复位…     

Successful pregnancy with intrauterine insemination using vasal sperm retrieved by electric stimulation

OBJECTIVE: To determine the feasibility of electric stimulation applied to the epididymis or vas deferens to retrieve vasal sperm. DESIGN: Two case reports. SETTING: Assisted reproduction practice in a hospital. PATIENT(S): Two patients with retrograde ejaculation and severe asthenozoospermia. INTERVENTION(S): Pulse electric simulation was applied to the epididymis or vas deferens to retrieve sperm via a tube cannulated into the vas deferens. After diluting with culture medium, retrieved sperm were used for IUI. MAIN OUTCOME MEASURE(S): The volume of retrieved vasal fluid and motility parameters of the sperm, the achievement of pregnancy, and outcome of pregnancy. RESULT(S): In patient 1, the volumes of vasal fluids and numbers of sperm were 10-40 microL and 31.4-75.9 x 10(6), respectively, during two cycles. Sperm motility was 88.4%--93.2%. His wife became pregnant and was delivered of a healthy infant by IUI during the second cycle. In patient 2, 0.6 x 10(6) sperm with a motility of 70% were retrieved and used for IUI. However, his wife did not become pregnant. CONCLUSION(S): Electric vasal sperm retrieval is a feasible method for collecting sperm from the vas deferens in selected patients with male factor infertility.     

The fertilizing ability of human epididymal sperm

Purpose: Membrane cofactor protein (MCP), CD46, whose primary function is to protect host cells from homologous complement, has been presumed to serve as a sperm adhesion molecule for oocytes. The purpose of this study was to clarify the relationship between the properties of MCP expressed on epididymal sperm and their fertilizing ability in a recently developed strategy for assisted reproduction. Methods: We collected ejaculated sperm from normal subjects and epididymal sperm from vasectomized subjects and patients with congenital absence of the vas deferens. Western blotting and cofactor activity assay were performed to investigated the structural and functional properties of MCP. Results: Epididymal spermatozoa which showed a reduced fertilizing ability tended to react poorly with antibodies against MCP and also showed low cofactor activity, indicating weak complement regulatory activity compared to that of ejaculated spermatozoa. Conclusions: MCP is sufficiently expressed in ejaculated sperm in men with a normally developed epididymis but is diminished in epididymal sperm from men with congenital or acquired obstruction of the vas deferens.     

Retrograde vasal sperm aspiration in anejaculatory patients with spinal cord injury

Aim :  This paper describes our experience with retrograde vasal sperm aspiration (ReVSA) in anejaculatory patients with spinal cord injury.
Methods :  We performed 11 vasal sperm aspiration procedures on eight patients presenting with neurogenic anejaculation associated with spinal cord injury at our institute between 2004 and 2007. This procedure was conducted under local anesthesia with a spermatic block. A 24G needle was inserted into the vas in a retrograde fashion. Sperm-washing medium was gently injected into the proximal vas several times and collected. Aspirated sperm was cryopreserved for intracytoplasmic sperm injection.
Results :  Adequate motile sperm was obtained from all patients. All couples underwent intracytoplasmic sperm injection; clinical pregnancies were achieved in eight cases (two ongoing pregnancies and the births of six healthy babies).
Conclusion :  Retrograde vasal sperm aspiration is a reliable method for the consistent recovery of sperm of sufficient quality to afford a high pregnancy rate and in sufficient quantity to permit cryopreservation of excess sperm for future use. (Reprod Med Biol 2008; 7 : 115–118)     

Efficacy of microsurgical epididymal sperm aspiration (MESA) and intracytoplasmic sperm injection (ICSI) in obstructive azoospermia

Purpose: Our purpose was to test whether micromanipulation using subzonal insemination and intracytoplasmic sperm injection could improve the poor fertilization and pregnancy rates obtained when attempting in vitro fertilization in patients with congenital absence of the vas deferens and unreconstructable obstructive azoospermia with microsurgically retrieved epididymal spermatozoa. Results: Conventional in vitro fertilization (group A; 14 cycles), subzonal insemination (group B; 13 cycles), and intracytoplasmic sperm injection (group C; 28 cycles) were carried out in 55 treatment cycles. Fertilization rates for groups A, B, and C were 16.1, 31.4, and 48.6%, respectively (P<0.05). Clinical pregnancy rates for groups A, B, and C were 7.1, 7.7, and 32.1% (P<0.05), respectively. In five cycles, intracytoplasmic sperm injection using epididymal sperm from alloplastic spermatoceles was performed and two clinical pregnancies (40%) were obtained. Conclusions: The combined microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection procedure is highly effective in improving the fertilization and pregnancy rate in congenital absence of the vas deferens and unreconstructable obstructive azoospermia. Furthermore, alloplastic spermatoceles may be useful for repeat sperm aspirations.Presented in part at the IXth World Congress on In Vitro Fertilization and Alternate Assisted Reproduction, Vienna, Austria, April 3–7, 1995.     

经皮穿刺附睾吸取精子卵浆内注射受精治疗不育

本文应用经皮穿刺附睾吸精子（ｐｅｒｃｕｔａｎｅｏｕｓｅｐｉｄｉｄｙｍａｌｓｐｅｒｍａｓｐｉｒａｔｉｏｎ，ＰＥＳＡ）经卵细胞浆内显微注射技术（ｉｎｔｒａｃｙｔｏｐｌａｓｍｉｃｓｐｅｒｍｉｎｊｅｃｔｉｏｎ，ＩＣＳＩ），对因精道不通致不育的８对夫妇进行治疗。按ＩＶＦ常规促超排卵方案及阴道Ｂ超取卵，共８个周期。ＰＥＳＡ有３例为输精管绝育术后吻合失败者，５例为先天双侧输精管缺如（ＣＢＡＶＤ），吸出精子活率１～８０％，精子密度２～８２×１０６／ｍｌ，共获６９个成熟卵母细胞，ＩＣＳＩ后７个卵子损伤，６２个存活，其中可见２原核正常受精的５０个，正常受精率为８０．６４％，至１９９８年８月已有５例妊娠，临床妊娠率为６２．５％，出生１例健康男婴，发育正常。结果显示，ＰＥＳＡ结合ＩＣＳＩ技术治疗精道不通不育，是一种有效的治疗方法。     

3106个不同来源精子ICSI周期临床妊娠结局分析

目的:分析精子的来源对卵胞质内单精子注射(ICSI)治疗结局的影响。方法:回顾性分析因男性不育行ICSI的3 106个新鲜周期,按精子来源分为:射精组(A组)、附睾穿刺取精(PESA)组(B组)、睾丸穿刺取精(TESA)组(C组)、冻融PESA精子组(D组)及冻融TESA精子组(E组),比较各组ICSI后胚胎发育及妊娠结局情况。结果:C组2PN受精率、卵裂率显著低于A组及B组;B组临床妊娠率、胚胎植入率显著高于A组及C组,A组、B组及C组间分娩率、异位妊娠率、流产率及新生儿畸形率无统计学差异(P>0.05);E组2PN受精率显著低于D组,但B组与D组之间、C组与E组间2PN受精率、优质胚胎率、多胎率、流产率及异位妊娠率均无统计学差异(P>0.05)。结论:PESA/TESA-ICSI、冻融PESA/TESA精子技术是治疗梗阻性无精子症安全有效的方法,建议首先选择附睾取精,并可将剩余PESA/TESA精子冻存。     

Microinsemination techniques for the treatment of patients suffering agenesia of the vas deferens

Thirty cycles of microsurgical epididymal sperm aspiration were performed on 27 patients presenting agenesia of the vas deferens. Two techniques of microinsemination were used, depending on the quality of the sperm preparation: subzonal sperm microinjection and microdroplet insemination. The results obtained by both microinsemination procedures are presented and discussed.     

Severe oligoasthenoteratozoospermias,secretory and obstructive azoospermias: Motility as a criterion of sperm viability

Purpose: Comparison of pregnancy rates in cases of Secretory Azoospermias (SA), Obstructive Azoospermias (OA) and severe Oligoasthenoteratozoospermias (OATZ). Evaluation of sperm motility as a quality criterion. Methods: In SA cases (n = 35), 9 samples were cryopreserved. In OA cases (epididymal aspiration: n = 91; testicular biopsy: n = 206), all samples were cryopreserved. 596 OATZ ejaculates were included. Results: In SA cases, 2 pregnancies were achieved from 9 ICSI cycles. In OA, motile sperm rates were higher in testicular biopsies. After thawing sperm motility was not different between testicular and epididymal origin. 2 pregnancies were achieved with immotile testicular sperm after thawing, but none with immotile epididymal sperm. In OATZ cases, one pregnancy was obtained from the 9 cryopreserved ejaculates and 35.3% with fresh motile sperm. Conclusions: In SA cases, the use of donor sperm is recommended due to the lower pregnancy rate achieved. Motility, before and after cryopreservation, as a criterion of sperm viability is discussed and its use should be reconsidered in some cases.