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。     

抽取附睾精子作人工授精治疗梗阻性无精子症初步报告

本文通过对5例梗阻性无精子症不育患者行输精管收集附睾精子、其中1例为附睾先天性梗阻,而作附睾-输精管吻合术外,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,共3例行人工授精。该法对输精管发育不全或炎症、损伤等因素造成的不能手术修复的远端输精管广泛损害梗阻的病人是一种较好的选择。     

抽取附睾精子作人工授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管收集附睾精子。其中除１例为附睾先天性梗阻，作附睾－输精管吻合术外，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，解冻复苏后４例行人工授精。该法对输精管发育不全或炎症、损伤等因素造成的不能手术修复的远端输精管广泛损害梗阻的病人是一种较好的治疗选择     

前列腺囊肿所致梗阻性无精子症的诊断与治疗(附7例报告)

目的 探讨前列腺囊肿所致梗阻性无精子症的诊断及其微创治疗的疗效和安全性评价。方法 回顾性分析2007年3月至2007年10月间诊治的7例前列腺囊肿所致梗阻性无精子症的临床资料。根据病史、体检、血清性激素、精液分析、精浆果糖测定和经直肠超声（TRUS）检查对其进行诊断，运用经直肠超声引导下前列腺囊肿穿刺引流术治疗，术后随访至少3个月以上。结果7例患者精液量0．5～1．8ml，pH值5．5～7．0，精浆果糖阴性。TRUS检查：前列腺囊肿均位于两侧射精管之间，单发，大小不等。所有患者均一次穿刺成功，6例术后查见精子，其中2例妊娠，其余病例精液质量有所恢复，妊娠情况在观察中。结论 病史、体检、精液分析、精浆果糖测定和TRUS是前列腺囊肿所致梗阻性无精子症的基本诊断手段，经直肠前列腺囊肿穿刺引流术治疗梗阻性无精子症安全、有效、经济、微创。     

附睾梗阻性无精子症手术效果的影响因素

梗阻性无精子症(obstructive azoospermia, OA)占男性不育的10%～15%,占无精子症的40%.附睾梗阻性无精子症(epididymal obstructive azoospermia,EOA)是OA的常见类型,目前治疗方法包括经皮附睾穿刺取精,施行IVF/ICSI或输精管附睾吻合术(vasoepididymostomy,VE),以重建生殖管道的通畅性.     

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.     

36例梗阻性无精子症附睾液中精子参数和细菌培养结果分析

目的 分析不同病因梗阻性无精子症患者附睾液中的精子参数和细菌培养结果 .方法 将36例梗阻性无精子症患者按不同病因分成A、B和C 3组,A组(14例)为有明确附睾炎症病史的附睾炎症梗阻;B组(7例)为无明确生殖道炎症病史的精道梗阻:C组(15例)为先天性双侧输精管缺如.将这些患者行诊断性经皮附睾穿刺精子抽吸术(PESA),分析附睾液中的精子参数,同时将附睾液做常规细菌培养和结核杆菌培养.结果 3组患者中,附睾精子密度≥20×106/ml,1～20×106/ml及≤1×106/ml的分别占33.3%(12/36),41.7%(15/36)和25%(9/36),各组间的精子密度无统计学差异(P>0.05):附睾液中有A或B级活动精子,仅有C级活动精子及仅有D级精子的患者分别占41.7%(15/36),36.1%(13/36)和22.2%(8/36),各组间的精子活动力无统计学差异(P>0.05):所有病例标本的常规细菌培养和结核杆菌培养均为阴性.结论 对于不同病因导致精道梗阻的患者,附睾液中精子的密度和活动力无统计学差异,大多数PESA附睾液标本中的精子足够用于单精子卵胞浆内注射(ICSI)治疗;梗阻性无精子症患者非急性炎症期附睾液中不存在活动性细菌感染,可以安全应用于ICSI治疗.     

CF基因在梗阻性无精子症的研究进展

囊性纤维化（Ｃｙｓｔｉｃｆｉｂｒｏｓｉｓ，ＣＦ）是白种人最常见的致死性常染色体隐性遗传病，发病率以北欧人群最高，约占活婴的１／２５００，致病基因携带率为１／２５。但近年来的研究发现，ＣＦ基因突变率在梗阻性无精子症患者中高达５０％～８２％。随着近几年辅助生殖技术的发展，使这类疾病的治疗有了新的突破，但致病的ＣＦ基因是否会通过此项技术而传给其下一代，一直是一个令人担扰的问题。为此现将ＣＦ病，ＣＦ基因及蛋白产物的结构特点与功能，ＣＦ基因突变与梗阻性无精子症的关系，致病的ＣＦ基因的遗传性综述如下。ＣＦ病…     

无精子症的病因分析

目的：对无精子症的病因进行分析。方法：对本院收治的１５０例无精子症患者进行回顾性研究,根据体检第二性征是否正常、两侧睾丸体积大小是否均匀、生殖激素测定正常与否,以初步鉴别是输精管阻塞性无精子症还是睾丸源性无精子症,然后作进一步相关检查,明确梗阻或生精障碍的确切病因。结果：输精管阻塞及缺如４１例,占２７．３％;生精障碍１０４例,占６９．３％;原因不明５例,占３．４％。结论：通过对无精子症病因的分析,     

Diagnosis and treatment of obstructive azoospermia

There are two types of azoospermia, namely, obstructive and nonobstructive azoospermia. Urologists play a more important role in the former, because many patients of the former can expect spontaneous pregnancy after surgical reconstruction of the seminal tract. In this review, we discuss about the causes, diagnosis, and treatment of obstructive azoospermia. The treatment includes vasovasostomy, epididymovasostomy, and transurethral resection of the ejaculatory duct. Surgical outcomes in our series are also described. The urologist must take care that the obstructive-azoospermic patients do not undergo unnecessary assisted reproduction procedures.     

睾丸细针穿刺吸液细胞学检查诊断阻塞性无精子症

目的 :观察睾丸细针穿刺吸液 ( FNA)细胞学检查的效果 ,为诊断阻塞性无精子症提供新的诊断方法。方法 :2 86例无精子症患者采用睾丸 FNA细胞学检查结合精浆生化指标测定及输精管造影对睾丸生精功能及阻塞部位进行诊断 ;以 42例精子密度在正常范围 ( 2 5～ 86× 1 0 6 / ml)的成年男性作为对照组。 2 4例做钳穿活检进行自身对照。结果 :( 1 )双侧输精管未触及者 58例 ,睾丸 FNA细胞学检查生精功能正常 2 6例 (可见较多生精细胞、精子细胞及精子 )、生精功能低下 2 4例、无生精功能 8例 ,精浆果糖在正常值范围 ,而肉毒碱及α-糖苷酶明显低于正常值范围 ;( 2 ) 3 2例睾丸 FNA细胞学检查见较多精子 ,精液沉渣涂片未见生殖细胞 ,其中 6例精浆果糖、肉毒碱及 α-糖苷酶明显低于正常值范围 ,结合输精管造影确诊为射精管阻塞 ,其余 2 6例精浆果糖在正常值范围 ,而肉毒碱及α-糖苷酶明显低于正常值范围 ,确诊为附睾尾部阻塞性无精子症 ;( 3 )睾丸生精功能极度低下或无生精功能 1 96例 ,其中 1 60例仅见各级生精细胞、精子细胞和支持细胞 (睾丸生精功能阻滞 ) ,3 6例仅见支持细胞 (唯支持细胞综合征 ) ,精浆果糖、肉毒碱及 α-糖苷酶均在正常值范围 ,为非阻塞性无精子症。结论 :睾丸 FNA细胞学检查可作为阻塞性无?     

Reconstruction of seminal ducts in obstructive azoospermia

Depending on the localization of the obstruction of the seminal ducts, either a microsurgical reconstruction (tubulovasostomy, vasovasostomy) or a transurethral resection of the ejaculatory ducts is carried out. We have compared the effectiveness and economic advantages of reconstructive microsurgery of the epididymis and vas deferens with standard procedures in animal experiments. Microsurgical invagination techniques in tubulovasostomy are equal to the standard procedure from the point of view of the patency and fertility rates. They are also easier to learn and carry out. Less time is required for the invagination technique, and also less microsurgical suture material. The double-layer technique in vasovasostomy is equal to the one-layer microsurgical technique from the point of view of patency and fertility rates. The one-layer technique requires less time and suture material. It seems that the discrepancy between the patency and the fertility rate is related to immunological processes after reconstruction of the seminal ducts. In cases of obstructive azoospermia it is necessary to investigate the individual conditions and possibilities of the infertile couple. As a result of the high success rate obtainable today by surgical reconstruction of the seminal ducts, this must constitute the first type of treatment to be considered, before any of the procedures of reproductive medicine are undertaken.     

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。     

手术治疗AO C型髋臼骨折

目的探讨手术治疗AOC型髋臼骨折的最佳手术时机和手术方法。方法自1999年2月～2004年1月共手术治疗AOC型（双柱）髋臼骨折46例，其中C1型23例，C2型14例，C3型9例。手术入路：髂腹股沟入路15例，改良Kocher-Langenbeck入路10例，前后联合入路21例。根据伤后距手术治疗的时间将46例患者分为3组：伤后第1周以内手术者15例（A组），第2周手术者23例（B组），第3周及以后者8例（C组）；手术前、后均行X线片、CT三维重建检查，并通过X线片随访。结果46例患者中解剖复位34例（73．9％），复位欠佳者8例（17．4％），小满意复位4例（8．7％）；随访12～36个月，平均31个月，采用D’Aubigne和Postel髋关节评分标准，功能表现优32例（69．6％），良5例（10．9％），可5例（10．9％），差4例（8．7％）。组间比较：复位程度A组与B组差异无显著性意义（P〉0．05），A、B组与c组间差异有极显著性意义（P〈0．01）；复位程度与D’Aubigne和Postel髋关节功能评分密切相关（P〈0．01）。髋关节功能A组与B组差异无显著性意义（P〉0．05），但与C组差异有极显著性意义（P〈0．01）。结论把各种影像学资料结合起来采用AO通用分型，能够全面了解骨折情况，正确诊断骨折类型；手术应尽可能在伤后2周内进行，并力求达到解剖复位。应用正确的复位和内固定方法是髋臼C型骨折取得良好疗效的关键。     

Microdissection testicular sperm extraction and IVF-ICSI outcome in nonobstructive azoospermia

We evaluated the efficiency of microdissection testicular sperm extraction (MicroTESE) in patients with nonobstructive azoospermia (NOA) and their pregnancy outcomes in a programme based on in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI). Fifty-six MicroTESE procedures were performed in 53 patients with NOA. Pre-operative levels of luteinising hormone, follicle-stimulating hormone (FSH), testosterone and prolactin were obtained and a Doppler sonography examination was conducted. Sperm retrieval rate, mean age of female partner, mean ICSI and fertilisation rate, number and quality of embryos transferred, implantation, pregnancy and miscarriage rates were calculated. Samples for testicular histological analysis were taken trans-operatively in every case. Sperm retrieval rate, mean ICSI per case and fertilisation rate were 57.1%, 7.4% and 58.4% respectively. A significant difference in pre-operative testicular volume ( P  = 0.001), serum FSH ( P  = 0.008) and total testosterone levels ( P  = 0.021) was found in patients from whom sperm could be retrieved. Mean 1.9 type A embryos were transferred per cycle. Implantation, clinical pregnancy and miscarriage rates were 20%, 40% and 18.7% respectively. It is concluded that MicroTESE is a viable option for men with NOA, offering excellent results in couples undergoing IVF-ICSI. Pre-operative serum FSH, testicular volume and total testosterone levels may have a prognostic value, although more data are needed to determine their significance and whether or not patients should be excluded from an initial sperm retrieval attempt.     

Clinical outcome of microsurgery for obstructive azoospermia

BACKGROUND: Recent technical advances in microscopy have greatly improved the reconstruction of the seminal tract in cases of obstructive azoospermia. METHODS: We evaluated the clinical outcome of 28 patients with obstructive azoospermia who underwent microsurgical reconstruction (i.e. vasovasostomy or unilateral epididymovasostomy). Diagnoses included postvasectomy (n = 9), childhood inguinal herniorrhaphy (n = 10) and cases of unknown cause (n = 9). Six of the unknown cases proved to be inoperable. We analyzed the outcome of the surgical reconstructions of operable cases according to the causes of obstruction, duration of obstruction, quality of the fluid obtained from the distal seminal tract (concentration, morphology and motility of sperm) and the histologic findings of the testis. RESULTS: The surgical outcome was analyzed with regard to the incidence of patency and pregnancy. The incidence of patency achieved in nine vasectomy cases was 89%, while the incidence of pregnancy was 44%. In contrast, the incidence of patency in the nine operable cases with herniorrhaphy was 44%, while the pregnancy rate was 0%. Of four cases of unknown cause who underwent epididymovasostomy, the incidence of patency was 100% and the incidence of pregnancy was 75%. The outcomes were worse in post-vasectomy cases with long-term obstruction of more than 10 years; however, this was not statistically significant. The outcome was significantly worse in cases with low sperm concentrations. There was no significant relationship between histologic findings and surgical outcome. CONCLUSIONS: The surgical outcome of vasovasostomy of postherniorrhaphy cases was significantly worse than that of post-vasectomy cases. With regard to epididymovasostomy, a unilateral repair was clinically evaluated.     

胰腺外伤的诊治和治疗(附3例报告)

目的探讨胰腺外伤的诊断、分型和治疗。方法本文对近1年诊治的腹部外伤中胰腺外伤3例进行回顾性分析,其中1例为胰腺头体交界处横断伤,1例为胰体尾裂伤,1例为胰腺外伤误诊后假性胰腺假性囊肿形成。结果3例胰腺损伤患者,均经手术治疗后痊愈出院,无并发症发生。结论对于有上腹部外伤的患者,外科医生要警惕胰腺外伤的可能,怀疑胰腺外伤的术中应仔细探查胰腺。强调胰腺外伤的早期合理治疗,有利于减少并发症和降低死亡率,手术方式视外伤分类而定。     

Morphological and morphometric attributes of epididymal and testicular spermatozoa following surgical sperm retrieval for obstructive and nonobstructive azoospermia

Whilst the morphological (shape) and morphometric (sperm head size) attributes of ejaculated spermatozoa have been well studied, the morphological and morphometric qualities of testicular and epididymal spermatozoa retrieved from males with obstructive and nonobstructive azoospermia is much less documented. We wished to examine the effect of aetiology of azoospermia and site of retrieval on the attributes of retrieved spermatozoa. This was a prospective observational study of 30 consecutive successful sperm retrievals, six for nonobstructive azoospermia and 24 for obstructive, of which five were retrieved from the epididymis and the remainder from the testis. The proportion of morphologically normal testicular spermatozoa in patients with obstructive and nonobstructive azoospermia was not significantly different (7% versus 7.6%, P = 0.97). Testicular spermatozoa from males with obstructive azoospermia showed an increase in frequency of sperm with small heads [47/180 (26%) versus 97/909 (11%), P = 0.036] as well as small acrosome and increasing vacuole formation over nonobstructive spermatozoa. Similarly, there was a significant increase in tail deformities and decreases in tail lengths in sperm from males with nonobstructive azoospermia. Epididymal spermatozoa showed significantly greater proportion of morphologically normal spermatozoa than testicular (20% versus 13%, P = 0.001) as well as a significant increase in acrosome vacuoles. Furthermore, morphometrically epididymal spermatozoa displayed with smaller head length, width and area than testicular spermatozoa. Testicular spermatozoa from obstructive azoospermia displayed significantly less tail defects (35% versus 57%, P = 0.003) as well as significantly longer tail lengths (30.6 microm versus 10.7 microm). These morphological and morphometric differences between epididymal and testicular and obstructive and nonobstructive spermatozoa may represent part of the natural maturation process. There were no associations between any morphological or morphometric abnormality with any significant parameter in subsequent use in ICSI.