阴囊超声用于选择梗阻性无精子症治疗方法

目的 探讨阴囊超声对于选择梗阻性无精子症治疗方式的价值。方法 前瞻性收集梗阻性无精子症患者93例行阴囊超声检查，观察附睾、输精管是否完整可见、有无扩张及钙化，测量扩张附睾管及输精管内径；根据后续治疗方式将其分为取精组（27例）和重建组（66例），比较2组病因及超声征象。采用ROC曲线评价超声参数用于筛选梗阻性无精子症治疗方式的临界值、敏感度、特异度、阳性预测值、阴性预测值和准确率。结果 2组间附睾形态异常、输精管细小或缺失、钙化及附睾管内径差异存在统计学意义（P均<0.05），睾丸体积及输精管内径差异均无统计学意义（P均>0.05）。以附睾管内径0.55 mm为临界值筛选梗阻性无精子症治疗方式，其敏感度87.47%，特异度86.70%，阳性预测值77.82%，阴性预测值92.76%，准确率87.03%。结论 阴囊超声对于选择梗阻性无精子症治疗方式具有重要临床意义。     

超声检查在无精症病因诊断中的应用价值

目的：探讨超声检查在无精症病因诊断中的应用价值。方法：回顾分析2015年1月1日至2021年12月31日在我院确诊为无精症的连续病例314例,总结分析其临床资料及超声检查的结果。结果：314例无精症患者中,梗阻性无精症(obstructive azoospermia,OA)患者118例（37.6%）,非梗阻性无精症(non-obstructive azoospermia,NOA)患者196例（62.4%）。OA患者中,有89%(105/118)超声检查有阳性发现,包括先天性双侧输精管缺如（40例）、射精管梗阻（33例）、炎症性病变（17例）、钙化性病变（15例）;NOA患者中,有40.3%(79/196)超声检查有阳性发现,包括小睾丸（45例）、隐睾（13例）、睾丸微石症（16例）、精索静脉曲张（5例）。结论：314例无精症患者中,NOA与OA之比为1.66∶1,经超声检查能明确其中58.6%患者的病因,能明确89%的OA病因及40.3%的NOA病因。     

输精管附睾吻合术治疗梗阻性无精子症临床初探

目的：探讨输精管附睾吻合术在梗阻性无精子症治疗中的作用。方法：选择6例确诊为梗阻性无精子症的患者进行阴囊探查,对其中4例施行输精管附睾吻合术,术后随访其疗效。结果：术后4例均获随访,2例于术后6个月精液中检出活精子,其中1例使配偶妊娠,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;应用输精管附睾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。     

梗阻性无精子症阴囊探查术87例分析

目的:探讨梗阻性无精子症(OAS)的病因和外科手术方式的疗效.方法:根据创伤性检测一般与治疗方案选择同步进行的原则,通过阴囊探查术,查明OAS的病因,对有手术指征者,同步复通输精管道,并对手术方式及疗效进行比较.结果:在87例OAS病因中,各种感染40例,先天性输精管、附睾病变30例.同步行各种输精管道复通术51例.探查术中发现先天性输精管缺如18例,先天性输精管畸形6例,先天性附睾畸形6例.结论:OAS病因中感染居首位,占46％.先天性输精管道病变34.5％,居第二位.所以预防和及时、正规治疗泌尿生殖道感染显得特别重要.显微镜下输精管附睾管吻合术是常用的手术方式,疗效较好.     

MD-TESE手术对非梗阻性无精子症患者取精结局的应用研究

目的观察MD-TESE对非梗阻性无精子症患者取精结局的影响。方法选取2012年6月-2015年3月来我院就诊的107例NOA患者为研究对象,其中TFNA组42人,TESE组30人,MD-TESE组35例,对比三组在取精成功率、术后并发症方面的差异,并观察术前与术后3个月血清总睾酮水平的变化。结果 TFNA组SRR为26%（11/42）,TESE组SRR为33%（10/30）,MD-TESE组SRR为48%（17/35）,MD-TESE组SRR均高于睾丸TFNA组（P〈0.01）和TESE组（P〈0.05）。三组术后均未发生感染和睾丸萎缩,TFNA组合TESE组分别有1例发生阴囊血肿,术后3个月血清总睾酮水平与术前无明显差异。结论MD-TESE是一项更安全、更有效的精子获取技术。     

梗阻性无精子症的临床诊断和外科治疗

梗阻性无精子症(OA)是男性不育的重要原因之一,约占无精子症的40%,其中射精管梗阻(ejaculato-ry duct obstruction,EDO)的发病率约为1%～5%。精浆生化检测技术和经直肠超声(TRUS)技术的广泛应用使越来越多的OA患者得以检出,近年来微创外科技术的发展使本病的诊断和治疗水平有了很大的提高。1临床表现OA缺乏特异性表现,患者可有射精乏力、精液量少、射精痛、血精、睾丸疼痛、会阴部不适、尿道口异常分泌物、腰背酸痛、排尿困难等症状,可合并有附睾炎     

生精细胞形态学检查联合血清FSH水平检测在NOA患者M-TESE中的应用价值

目的 探讨精液生精细胞形态学检查联合血清卵泡刺激素(FSH)水平检测在非梗阻性无精子症(NOA)患者睾丸显微取精术(M-TESE)中的应用价值。方法 以2019年10月至2021年10月在该院生殖医学中心接受M-TESE的41例NOA患者为研究对象,采集精液标本进行生精细胞形态学检查和血清FSH水平检测。将精液生精细胞形态学检查检出生精细胞的患者作为阳性组,未检出生精细胞的患者作为阴性组;显微镜下找到成熟精子为M-TESE成功,未找到成熟精子为M-TESE未成功。分析两组患者的血清FSH水平和M-TESE的成功率。结果 41例NOA患者中,阳性组18例,占43.9%;阴性组23例,占56.1%。M-TESE成功15例,未成功26例,总成功率为36.6%,其中阳性组M-TESE成功率为66.7%(12/18),阴性组M-TESE成功率为13.0%(3/23),两组的M-TESE成功率比较,差异有统计学意义(P<0.001)。阳性组血清FSH水平为(27.2±14.2)mIU/mL,阴性组为(39.3±15.0)mIU/mL,差异有统计学意义(P=0.012)。结论 NOA患者精液生...     

显微镜下输精管附睾吻合术治疗梗阻性无精子症

梗阻性无精子症(obstructive Azoospermia,OA)是指由于双侧的输精管管道梗阻导致在精液中和射精后尿液中既没有精子也没有生精细胞。梗阻性无精子症比非梗阻性无精子症发生率低,大约占无精子症的15%～20%。以往对于梗阻性无精子症的     

超声对梗阻性无精子症的诊断价值

无精子症临床上分为梗阻性和非梗阻性,其中梗阻性无精子症是男性不育的重要原因之一,占10％～15％。在超声检查开展以前,精道梗阻主要依靠X线造影诊断,但由于其放射损伤性及电离辐射对男性不育患者的潜在影响,在临床上使用一直受到限制。目前,经直肠超声和经阴囊超声为输精管道的诊断提供了无创的影像学检查。     

30例无精子症精道造影临床分析

目的：探讨经皮输精管穿刺精道造影对诊断无精子症的价值。方法：对30例采用经皮输精管穿刺精道造影的无精子症患者临床资料进行回顾性分析总结。结果：精道异常的发现率73％，以生殖道感染炎症所致精道阻塞多见。结论：经皮输精管穿刺精道造影是一项渗断无精子症安全、有用的方法。     

显微纵向两针套叠式输精管附睾吻合术治疗梗阻性无精子症的临床研究——附24例报告

目的：探讨显微纵向两针套叠式输精管附睾吻合术治疗梗阻性无精子症的疗效.方法：选取梗阻性无精子症不育患者46例,分为治疗组24例及对照组22例.治疗组采用显微纵向两针套叠式输精管附睾吻合术治疗,对照组采用传统的输精管附睾端端吻合术或端侧吻合术.术后每月复查精液1次,随访配偶受孕率.结果：随访6 ～13个月,研究组从精液中检出精子18例（75%）,对照组检出精子4例（18%）;研究组6例（25%）配偶受孕成功,对照组1例（4.5%）配偶受孕成功,两组比较差异均有统计学意义（P﹤0.05）.结论：显微镜下纵向两针套叠式输精管附睾吻合术能够严密而准确地对合管腔,较传统的输精管附睾端端吻合术或端侧吻合术,提高了输精管道复通率和配偶受孕率.     

Role of transrectal ultrasonography in the evaluation of azoospermic men with low-volume ejaculate.

OBJECTIVE: The purpose of this prospective study was to evaluate the incidence of distal ejaculatory system defects with transrectal ultrasonography (TRUS) among patients evaluated for azoospermia. METHODS: Forty-two patients with low-volume ejaculate and azoospermia were evaluated by physical examination, serum follicle-stimulating hormone and luteinizing hormone level determination, karyotyping, selective screening for cystic fibrosis mutations, and TRUS. RESULTS: On physical examination, in 29 patients (69%), either 1 (12 patients) or both (17 patients) of the vasa deferentia could not be palpated. In the group of 17 patients with bilateral involvement of the vasa deferentia, the ultrasonographic imaging universally showed bilateral absence or hypoplasia of the seminal vesicles with bilateral agenesis of the vasa deferentia and nonvisualization of both ejaculatory ducts. In the patients with a unilateral abnormality on physical examination, the ultrasonographic imaging showed absence of the ipsilateral seminal vesicle in 7 patients and the hypoplastic seminal vesicle in 5. In the group of 13 patients with normal physical examination findings, a variety of obstructive causes were diagnosed by TRUS examination. CONCLUSIONS: According to this study, TRUS appears to be a sensitive method for evaluating the anatomy of the distal ejaculatory system. Its safety and low costs make it a good alternative to the other invasive and expensive methods.     

Predictors of testicular sperm retrieval in patients with non-obstructive azoospermia: a review

Azoospermia is divided into two categories of obstructive azoospermia and non-obstructive azoospermia. Before 1995, couples with a male partner diagnosed with non-obstructive azoospermia had to choose sperm donation or adoption to have a child. Currently, testicular sperm aspiration or micro-dissection testicular sperm extraction combined with intracytoplasmic sperm injection allows patients with non-obstructive azoospermia to have biological offspring. The sperm retrieval rate is significantly higher in micro-dissection testicular sperm extraction compared with testicular sperm aspiration. Additionally, micro-dissection testicular sperm extraction has the advantages of minimal invasion, safety, limited disruption of testicular function, a low risk of postoperative intratesticular bleeding, and low serum testosterone concentrations. Failed micro-dissection testicular sperm extraction has significant emotional and financial implications on the involved couples. Testicular sperm aspiration and micro-dissection testicular sperm extraction have the possibility of failure. Therefore, predicting the sperm retrieval rate before surgery is important. This narrative review summarizes the existing data on testicular sperm aspiration and micro-dissection testicular sperm extraction to identify the possible factor(s) that can predict the presence of sperm to guide clinical practice. The predictors of surgical sperm retrieval in patients with non-obstructive azoospermia have been widely studied, but there is no consensus.     

Normal and variant appearances of the adult epididymis and vas deferens on high-resolution sonography

PURPOSE: To describe the appearance, anatomic position, and size of the normal adult epididymis and vas deferens using high-resolution sonography. METHODS: The sonographic appearance, anatomic position, and size of the epididymal head (EH), epididymal body (EB), epididymo-deferential loop (EDL), and vas deferens (VD) were evaluated in 112 consecutive infertile men (infertile group), and the data were compared with those from 84 consecutive men without history of infertility (reference group). RESULTS: Compared with the testis, the EH was isoechoic, the EB hypoechoic, and the VD anechoic. In 88.4% of cases in the infertile group and 97.6% of cases in the reference group, the EH was located above the upper pole of the testis, with the EB lateral to the testis and the EDL below the lower pole of the testis. In 9% of cases in the infertile group and 6% of cases in the reference group, the EB was located posterior to the body of the testis, with the EDL inverted and the VD anterior to the ET. In 11.6% of cases in the infertile group and 2.4% of cases in the reference group, the epididymis was inverted, with the EH located below the lower pole of the testis. The mean (+/-SD) normal sizes were as follows: EH, 7.6 +/- 1.6 mm; EB, 3.2 +/- 0.8 mm; EDL, 7.7 +/- 1.3 mm; VD, 1.9 +/- 0.2 mm. No statistically significant differences in size were found between the 2 groups. CONCLUSIONS: We describe the normal and variant appearance, position, and size of the adult epididymis and VD on high-resolution sonography.     

腹腔镜腹膜阴道成形术的临床研究

目的：利用腹腔镜微创手术技术探索阴道成形术的理想术式。方法：对2001年11月～2004年8月收治的38例先天性无阴道 患者施行腹腔镜腹膜阴道成形术，总结分析其手术情况及手术效果。结果：38例手术中，除2例中转开腹改行乙状结肠阴道成形术 外，其余36例均获成功。术后随访近3年，再造阴道深8～10cm，可容窥阴器，阴道粘膜粉红色、湿润、其柔软度、弹性及走向符合解剖 结构及生理要求。结论：腹腔镜腹膜阴道成形术手术简单、安全、创伤小、术后患者恢复快，临床效果好，是一种较理想的阴道成形术 术式，值得广泛推广应用。     

阴道超声对诊断剖宫产术后子宫切口憩室的临床价值

目的探讨经阴道超声检查在剖宫产后子宫切口憩室诊断中的应用价值。方法对32例剖宫产患者术后子宫切口憩室的临床资料进行了回顾性分析。结果本组32例患者中子宫切口憩室均伴积血积液,阴道超声诊断符合率达到100％。结论阴道超声检查对剖宫产切口憩室的诊断价值较高,临床操作简单,诊断准确,值得在临床推广应用。     

经颅彩色编码超声诊断帕金森综合征的临床价值

目的 探讨经颅彩色编码超声(TCCS)诊断帕金森综合征(PD)的价值。方法 选择52例PD患者(PD组)和50例健康人群(对照组),经颞窗探查中脑区黑质(SN)的回声强度,对其进行分级,并测量SN强回声的面积及双侧黑质强回声/中脑面积(S/M)值。结果 TCCS显示SN出现强回声41 (/52, 78.8%)例,而对照组出现SN强回声为19 (24.0%)例,两组差异有统计学意义(X 2 = 4.766, P = 0.000)。PD组单侧SN强回声面积0.34±0.10 cm2,S/M为11±4%;对照组单侧SN强回声面积0.17±0.05 cm2,S/M为5±1%。PD组与对照组SN强回声面积及S/M均有明显统计学差异(t = 9.859, p = 0.000; t = 10.394, p = 0.000)。依据受试者工作特征曲线,以S/M为6.5%作为诊断PD临界值,其曲线下面积为0.964,敏感性为98.1%,特异性为84.6%;以单侧SN强回声面积0.215作为诊断PD的临界值,其曲线下面积为0.929,敏感性为88.5%,特异性为75.0%。结论 TCCS对于预测正常人群中罹患PD的风险及早期诊断PD具有重要临床应用价值。     

阻塞性睡眠呼吸暂停低通气综合征患者脑血管储备功能的研究

目的评价阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者脑血管储备能力（CVR）。方法选择114例OSAHS患者和43名健康人作为研究对象。114例OSAHS患者根据呼吸暂停低通气指数（AHI）和夜间最低血氧饱和度（LSaO2）分为轻、中、重度组。对所有受试者均采用经颅多普勒超声检测仪和CO2分压检测仪,通过吸入自身CO2气体诱导高碳酸血症、过度换气诱导低碳酸血症的方法来测定脑血管储备功能。结果中、重度OSAHS患者低碳酸血症时CVR分别为（1．80±1．34）、（1．43±1．05）％／mmHg明显低于健康对照组（2．93±0．93）％／mmHg,差异均有统计学意义（P均〈0．05）;轻度OSAHS患者CVR为（2．53±1．83）％／ramHg,与健康对照组比较差异无统计学意义（P〉0．05）。高碳酸血症时中、重度OSAHS患者CVR分别为（1．83±1．32）、（1．08±1．00）％／ramHg明显低于健康对照组（3．32±1．53）％／mmHg,差异均有统计学意义（P均〈0．05）;AHI与低、高碳酸血症脑血管储备之间呈负相关（r值分别为-0．665、-0．721;P均〈0．05）。结论吸入CO2方法可用于CVR功能的评价。CVR与AHI相关。中、重度OSAHS患者由于缺氧严重,CVR能力降低使血流动力学发生变化。     

Congenital absence of the portal vein associated with focal nodular hyperplasia in the liver in an adult woman

We present a new case of congenital absence of the portal vein and focal nodular hyperplasia in the liver without additional congenital anomalies. Ultrasound, computed tomography, magnetic resonance imaging, and angiography depicted the splenic vein and the superior mesenteric vein joining and entering into the inferior vena cava without passing through the liver. The features of this patient and the 30 previously reported cases are reviewed.