经尿道射精管切开术联合精囊镜技术治疗 射精管梗阻性无精子症（附22例报告）

Combination of transurethral resection of ejaculatory duct with transurethral seminal vesicloscopy for treatment of azoospermia with ejaculatory duct obstruction (a report of 22 cases)

摘要:

目的 探讨经尿道射精管切开术(TURED)联合精囊镜技术治疗射精管梗阻性无精子症的可行性与疗效。方法 对2008年7月～2012年5月收治的22例患者，采用精液常规、精浆果糖测定和经直肠超声(TRUS)等检查明确射精管梗阻性无精子症诊断。22例TRUS提示单纯射精管扩张6例，射精管扩张合并射精管结石3例，单纯精囊扩张4例，精囊及射精管扩张5例，精囊扩张合并前列腺囊肿2例，单纯前列腺囊肿2例。所有患者均由同一具备多例经尿道手术经验的高年资医师实施手术，术后半年随访评估手术疗效。结果 该组患者均成功完成手术，手术时间为20～78 min，术后半年复查射精管梗阻解除，自觉症状好转或消失，18例(81.8%)患者精液中检出活精子，16例(72.7%)精液质量有不同程度的改善，7例(31.8%)妻子妊娠。该组患者无严重并发症发生。结论 TURED联合精囊镜技术是治疗射精管梗阻性无精子症的微创、有效的方法，值得临床应用。

Abstract:

【Objective】 To evaluate the feasibility and efficacy of transurethral resection of ejaculatory duct (TURED) combined with transurethral seminal vesicloscopy for azoospermia with ejaculatory duct obstruction (EDO). 【Methods】 The clinical data of 22 cases of azoospermia with EDO from July 2008 to April 2012 were analyzed. The diagnostic criteria included history, physical examination, semen analysis, fructose in seminal plasma, chromosome analysis, endocrine assessment, testicular biopsy and transrectal ultrasonography (TRUS). TRUS showed pure dilation of ejaculatory ducts in 6 cases, dilated ejaculatory ducts and ejaculatory duct stones in 3 cases, pure dilation of seminal vesicles in 4 cases, dilation of both seminal vesicles and ejaculatory ducts in 5 cases, dilated seminal vesicles and prostatic cysts in 2 cases, pure prostatic cysts in 2 cases. All the patients were treated with TURED combined with transurethral seminal vesicloscopy by the same experienced surgeon, and followed up over 6 months after operation. 【Results】 22 patients undertook TURED combined with transurethral seminal vesicloscopy successfully. Allthe patients' ejaculatory duct obstruction was relieved 6 months after operation. The pre-operative symptoms decreased or disappeared. Semen volume ranged from 1.9 to 5.7 milliliters (significantly increased, P ＜0.05), and fructose in seminal plasma ranged from 3.2 to 63.8 micromoles per ejaculation (significantly increased, P ＜0.05). Living sperm could be found in 18 patients’ seminal fluid (81.8%), 16 patients (72.7%) obtained improved semen parameters, and 7 patients’ wives (31.8%) gained pregnancies, no severe complications occurred. 【Conclusions】 TURED combined with transurethral seminal vesicloscopy is a minimally invasive and effective method for treatment of azoospermia with EDO, It is worthy of clinical application.