摘要
目的对比分析细针穿刺输精管造影和经直肠B超(TRUS)对射精管梗阻性无精子症的诊断中作用,以期为探讨国人射精管梗阻性无精子症的最佳影像学诊断方法提供依据。方法2005年7月至2007年7月间,对45例经精液分析和TRUS疑诊为双侧射精管梗阻(EDO)性无精子症的患者行开放性细针穿刺输精管造影检查。患者精液分析应具有典型的"四低"特点和(或)具有TRUS检查的典型EDO改变。结果45例患者中,同时具有典型的精液分析"四低"特点和TRUS检查改变的患者15例(33.33%),精液分析有"四低"特点而TRUS检查无典型改变者12例(26.67%),TRUS检查有典型改变而精液分析不具备"四低"特点者18例(40%)。开放性细针穿刺输精管造影检查显示:双侧输精管起始段、附睾部梗阻患者19例,双侧输精管梗阻、发育不良患者15例,双侧射精管梗阻仅3例(6.67%),一侧输精管梗阻、一侧射精管梗阻患者2例,一侧输精管起始段及附睾部梗阻、一侧输精管梗阻或发育不良者6例。仅1例患者出现,是因造影后不遵医嘱过早活动出现阴囊血肿,保守治疗后自行吸收。结论单纯依靠TRUS进行射精管梗阻诊断的价值有限,考虑与TRUS仅能显示静止的精囊、射精管情况有关。开放性细针穿刺输精管造影在梗阻性无精子症诊断中有重要作用。
Objective To study on the opening fine needle vasography for diagnosis of patients with ejaculatory duct obstruction （EDO） and provide the base for imaging diagnosis of Chinese EDO. Methods From July of 2005 to July of 2007, all of 45 infertile male patients suspected of bilateral ejaculatory duct obstruction in our hospital underwent vasopuncture and opening fine needle vasography. The diagnostic criteria of infertile patients included pathognomonic changes of semen analysis and/or pathognomonic findings of TRUS on EDO. Results In the 45 patients suspected of complete EDO, 15 （33.33%） of them showed pathognomonic changes on both semen analysis and TRUS; other 12 （26.67%） showed typical characteristic changes on semen analysis but no typical findings on TRUS. The other 18 patients（40%） showed pathognomonic findings on TRUS but not typical characteristics on semen analysis. The results of vasopuncture and fine needle vasography were more precise and definite. Only 3 patients（6.67%） was confirmed as bilateral ejaculatory duct obstruction, 19 patients as obstruction of the epididymis and the proximal vas deferens, 15 patients as bilateral multiple vasal obstruction or congenital agenesis, 2 patients as unilateral EDO and contralateral vasal multiple obstruction and the other 6 patients as unilateral vasal multiple obstruction or congenital agenesi＇s and contralateral obstruction of the epididymis and the proximal vas deferens. Besides, one patient got scrotal hematoma as the result of uncompliance and premature activity, and the hematoma was absorbed by expectant treatment. No other severe complications were found. Conclusion The results suggested that the diagnostic effect of transrectal ultrasonography （TRUS） was under limit of its reliability. As an invasiveness radiorgraphic imaging method, opening fine needle vasography was still considered as an effective means for identification and diagnosis of ejaculatory duct obstruction.
出处
《中国男科学杂志》
CAS
CSCD
2009年第6期28-33,共6页
Chinese Journal of Andrology
关键词
射精管梗阻
不育
输精管造影
超声检查
经肠
ejaculatory duct obstruction
infertility
vasography
ultrasonography, transrectal
