中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2012年
11期
843-846
,共4页
平萍%马猛%陈向锋%孙凯%刘毅东%周立新%黄翼然%李铮
平萍%馬猛%陳嚮鋒%孫凱%劉毅東%週立新%黃翼然%李錚
평평%마맹%진향봉%손개%류의동%주립신%황익연%리쟁
不育,男(雄)性%精索静脉曲张%无精子症%精子获得率%显微外科手术
不育,男(雄)性%精索靜脈麯張%無精子癥%精子穫得率%顯微外科手術
불육,남(웅)성%정색정맥곡장%무정자증%정자획득솔%현미외과수술
Infertility,male%Varicocele%Azoospermia%Sperm retrieval rate%Microsurgery
目的 探讨显微外科技术在男性不育症治疗中的应用及疗效. 方法 回顾性分析2007年3月至2012年3月853例接受显微外科治疗的不育男性患者资料.其中精索静脉曲张的少弱精子症患者344例,均在硬膜外或全麻下接受精索静脉曲张显微结扎术.梗阻性无精子症患者252例,接受输精管-输精管显微吻合术60例,其中45例有双侧输精管结扎史,15例有双侧疝气手术史；其他192例接受输精管-附睾管显微吻合术.非梗阻性无精子症患者257例,均在全麻下接受睾丸显微取精术,并行病理检查.患者术后门诊随访1～12个月,随访内容为手术并发症、精液参数及女方妊娠情况. 结果 ①344例精索静脉曲张患者术后3个月复查精液,术前精子密度为(10±6)×106/ml,前向运动精子比率为(16±9)％,术后精子密度为(15 ±8)×106/ml,前向运动精子比率为(28±14)％,48.8％(168/344)的患者术后精液质量提高,10.8％ (37/344)的患者配偶自然受孕.②输精管输精管显微吻合术共60例,总复通率为80.0％ (48/60),妊娠率为35.0％ (21/60).192例接受输精管附睾管显微吻合术,复通率为53.1％(102/192),妊娠率为19.8％ (38/192).③257例非梗阻性无精子症患者睾丸活检精子检出率为38.1％(98/257),显微取精法精子获取率为60.3％(155/257),显著性高于活检术(P＜0.01).仅2例患者出现阴囊血肿,经清创换药处理后治愈. 结论 显微外科技术治疗男性不育症可有效改善和恢复男性生育力,创伤小,降低医疗费用,符合生殖伦理.
目的 探討顯微外科技術在男性不育癥治療中的應用及療效. 方法 迴顧性分析2007年3月至2012年3月853例接受顯微外科治療的不育男性患者資料.其中精索靜脈麯張的少弱精子癥患者344例,均在硬膜外或全痳下接受精索靜脈麯張顯微結扎術.梗阻性無精子癥患者252例,接受輸精管-輸精管顯微吻閤術60例,其中45例有雙側輸精管結扎史,15例有雙側疝氣手術史；其他192例接受輸精管-附睪管顯微吻閤術.非梗阻性無精子癥患者257例,均在全痳下接受睪汍顯微取精術,併行病理檢查.患者術後門診隨訪1～12箇月,隨訪內容為手術併髮癥、精液參數及女方妊娠情況. 結果 ①344例精索靜脈麯張患者術後3箇月複查精液,術前精子密度為(10±6)×106/ml,前嚮運動精子比率為(16±9)％,術後精子密度為(15 ±8)×106/ml,前嚮運動精子比率為(28±14)％,48.8％(168/344)的患者術後精液質量提高,10.8％ (37/344)的患者配偶自然受孕.②輸精管輸精管顯微吻閤術共60例,總複通率為80.0％ (48/60),妊娠率為35.0％ (21/60).192例接受輸精管附睪管顯微吻閤術,複通率為53.1％(102/192),妊娠率為19.8％ (38/192).③257例非梗阻性無精子癥患者睪汍活檢精子檢齣率為38.1％(98/257),顯微取精法精子穫取率為60.3％(155/257),顯著性高于活檢術(P＜0.01).僅2例患者齣現陰囊血腫,經清創換藥處理後治愈. 結論 顯微外科技術治療男性不育癥可有效改善和恢複男性生育力,創傷小,降低醫療費用,符閤生殖倫理.
목적 탐토현미외과기술재남성불육증치료중적응용급료효. 방법 회고성분석2007년3월지2012년3월853례접수현미외과치료적불육남성환자자료.기중정색정맥곡장적소약정자증환자344례,균재경막외혹전마하접수정색정맥곡장현미결찰술.경조성무정자증환자252례,접수수정관-수정관현미문합술60례,기중45례유쌍측수정관결찰사,15례유쌍측산기수술사；기타192례접수수정관-부고관현미문합술.비경조성무정자증환자257례,균재전마하접수고환현미취정술,병행병리검사.환자술후문진수방1～12개월,수방내용위수술병발증、정액삼수급녀방임신정황. 결과 ①344례정색정맥곡장환자술후3개월복사정액,술전정자밀도위(10±6)×106/ml,전향운동정자비솔위(16±9)％,술후정자밀도위(15 ±8)×106/ml,전향운동정자비솔위(28±14)％,48.8％(168/344)적환자술후정액질량제고,10.8％ (37/344)적환자배우자연수잉.②수정관수정관현미문합술공60례,총복통솔위80.0％ (48/60),임신솔위35.0％ (21/60).192례접수수정관부고관현미문합술,복통솔위53.1％(102/192),임신솔위19.8％ (38/192).③257례비경조성무정자증환자고환활검정자검출솔위38.1％(98/257),현미취정법정자획취솔위60.3％(155/257),현저성고우활검술(P＜0.01).부2례환자출현음낭혈종,경청창환약처리후치유. 결론 현미외과기술치료남성불육증가유효개선화회복남성생육력,창상소,강저의료비용,부합생식윤리.
Objective To discuss the application of microsurgery in the treatment of male infertility.Methods From March 2007 to March 2012,there were totally 853 infertile men received microsurgical treatments in our department.Among them,344 patients with unilateral or bilateral varicocele underwent microsurgical varicocelectomy,60 underwent vasovasostomy (VV) and 192 underwent vastoepidystomy (VE)in microsurgical methods due to obstructive azoospermia.257 non-obstructive azoospermia (NOA) patients were performed microdissection of testicular sperm extraction (MD-TESE),at the same time,pathologic examination was done.Results ①For the varicocele patients,the pre-operative sperm density was (10 ±6) × 106/ml,the progressive sperm percentage was (16 ± 9)％.The post-operative density was (15 ± 8) ×106/ml,the progressive sperm percentage was (28 ± 14)％.The natural pregnant rate was 10.8％ (37/344).②In 60 patients undergone VV,the patent rate was 80.0％ (48/60),the natural pregnant rate was 35.0％ (21/60).In 192 VE patients,the patent rate was 53.1％ (102/192),the natural pregnant rate was 19.8％ (38/192).③In 257 NOA patients,the testicular volume,sperm retrieval rate of MD-TESE was significantly higher than that of conventional testicular sperm extraction (60.3％ vs.38.1％).Conclusion The microsurgery techniques in male infertility treatments could have some advantages such as explicit effects and decreased injuries.
