40例输精管道梗阻性无精子症诊疗策略分析

目的:探讨输精管道梗阻性无精子症(OA)的诊疗策略。方法:40例输精管道OA患者为研究对象。首先行输精管道探查,根据术中探查情况行输精管-输精管显微吻合术(VV)、输精管-附睾显微吻合术(VE)、交叉输精管-输精管吻合术、交叉输精管-附睾管显微吻合术或睾丸取精冻存术。结果:精道探查后,共行吻合手术26例,取精+冻精手术14例。40例患者中,共有3例患者失访(2例吻合患者,1例冻精患者)。随访到的24例吻合术患者术后复通率为58.3%(14/24),自然受孕率为29.1%(7/24)。随访到的13例取精+冻精患者中已有11例行ICSI/冻精助孕。结论:输精管道OA,可根据术前严格评估和术中探查行显微复通手术或取精术;复通术后可获得自然妊娠的机会,交叉显微吻合为输精管道复通的有效途径之一。

Strategic analysis of treatment to 40 cases of vas deferens obstructive azoospermia

Objective: To investigate the strategy of operation treatment to vas deferens obstructive azoospermia(OA). Methods: There were totally 40 vas deferens OA patients received microsurgical treatments.Various patients were preformed vasovasostomy(VV), vastoepidystomy(VE), transsceptal crossover VV,transsceptal crossover VE or microdissection of testicular sperm extraction(MD-TESE) with cryopreserved.Results: Among the 40 patients, 26 patients were performed VV or VE, 14 were performed MD-TESE with sperm cryopreserved, and 3 patients were lost to follow-up. In 26 patients undergone VV or VE, the patent rate was58.3%(14/24), the natural pregnant rate was 29.1%(7/24). In 13 patients who undergone MD-TESE with sperm cryopreserved, 11 couples got pregnant by ICSI using frozen sperm collected at operation. Conclusion: The microsurgery techniques in vas deferens OA treatments have an obvious advantage, especially the chance for achieving natural preganancy, so it has the value of promotion. The transsceptal crossover VE or VE should be considered for some patients.