输精管结扎术后附睾瘀积综合征发病机制、诊断与治疗探讨

为了阐明输精管结扎术后附睾瘀积综合征的发病机制，探讨诊断与治疗方法，收集１０例病人，行血清及精浆抗精子抗体测定及Ｂ超、Ｃ超、ＭＲＩ等项硷查。手术采用附睾一近睾端输精管。结扎结节整块切除术。术中取附睾液行细菌培养及睾丸活检，标本行光镜和电镜检查。术后随访，９例治愈，１例无效。瘀积附睾的组织学检查表明是附睾对外漏精子的无菌性炎症反应。睾丸活检，生精过程正常２侧，其同侧结扎断端有精子肉芽肿形成，提示输精管结扎断端精子肉芽肿的形成对睾丸有保护作用。

Studies of pathogenesis,diagnosis and treatment of postvasectomy epididymal stasis svndrome

bjectives : To study the diagnosis and treatment of epididymal stasis syndrome after vasectomv and to discuss on the pathogenesis of the syndrome. Design : Clinical and laboratory studies. setting :Hospital clinic and research institute in shangdong.subjects :ten patients aged 29～46 with epididymal stasis syndrome for 3～ 10 years after vasectomy. Intervention :A total removal of epididymis, proximal vas deferens and nodules at the cut end of vas deferens. Methods :RoutIne semen analysis ,assays of antisperm antibodies in serurn and seminal plasma , ultra-sonography and magnetic resonance examination,bacteria culture of epididyrmal fluid,testicular biopsy for histologic examination with light and electron microscopy. Results :Operation was successful in 9 cases. All cultures of epididymal fluid were devoid of bacteria growth. The histologic examination demonstrated sperm extravasation in epididymal interstitial tissue. Tes-ticular biopsy showed degeneration and arrest of spermatogenesis in 8 testes and normal spermatogenesis in 2 testes with spermatic granuloma at the cut end of vas. Conclusion :The mechanism underlying the epididymal stasis syndrome is attributable to non-bacterial inflammatory reaction to the extravasation of sperm in epididymal interstitial tissue. The spermatic granulo-ma at the cut end of vas might have some protective effect on the testicular spermatogenesis.