经皮附睾和睾丸细针穿刺抽吸术在诊断梗阻性无-第三军医大学学报.docVIP

经皮附睾和睾丸细针穿刺抽吸术在诊断无精子症中的应用 桂文武 丘 彦 蒲 军 幸贵邦 陈 莹 孟江萍 （重庆医科大学附属第一医院妇产科辅助生殖中心，重庆 400016） 摘 要: 目的 研究经皮附睾(PESA)和睾丸细针穿刺抽吸术(TESA)在无精子症诊断中的应用价值。方法 在诊断为无精子症的患者中，经睾丸体积测定、血清性激素水平、生殖系统B超等检查后，选择符合穿刺条件者168例,用细针于局麻下行PESA或PESA+TESA(PESA/TESA),对抽吸获得组织显微镜下检查。结果 PESA/TESA结果显示,168例中未见精子41例(22.4%)。PESA/TESA联合睾丸体积、血清FSH水平,对无精子症进行诊断符合率为91.3%。结论 PESA/TESA细针操作简单且创伤小,是诊断无精子症的可靠方法。 关键词:经皮附睾穿刺精子抽吸术;经皮睾丸穿刺精子抽吸术;无精子症 Application of percutaneous epididymal sperm aspiration and testicular sperm aspiration by fine needle in diagnosis of azoospermia GUI Wen wu, et al (Department of Obstetrics and Gynecology,The First Affiliated Hospital,Chongqing Medical University) Abstract：Objective To investigate the value of percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) by fine needle aspiration in diagnosis of azoospermia.Methods Azoospermia was diagnosed in 168 patients after detection of centrifuged seminal fluid.After examinationsof testis volume, serum gonadal hormone level,seminalplasma biochemicalparameters and B ultrasound of genital system,PESA or PESA+ESA(PESA/TESA) was performed by fine needle. Histopathologic examination and sperm count were conducted for tissues available. Results Azoospermia were diagnosed in 41(22.4%) patients by PESA/TESA.The correspondence rates of PESA/TESA combined with examinations of testis volume, serum FSH level for azoospermia were 91.3%.Conclusion PESA/TESA by fine needle is a convenient, minimally invasive and reliable method in the diagnosis of azoospermia. Key words: percutaneous epididymal sperm aspiration;testicular sperm aspiration; azoospermia 男性不育中无精子症占10%～20%，是男科的常见疾病，为男性不育症中最为严重的一种，病因复杂，可分为梗阻性无精子症和非梗阻性无精子症。睾丸活体组织检查(活检)评价生精功能已沿用多年[1,2]，但因手术对睾丸损伤较大及术后出现疼痛和某些并发症，而使其应用受限。粗针吸取睾丸活检虽能满足临床要求，但对睾丸的损伤仍未降到理想程度。为探索一种更好的穿刺方法，我们在临床工作中用细针穿刺睾丸和附睾，现报告如下。 1.对象与方法 1.1研究对象：2008年4月～2009年10月就诊于重庆医科大学附属第一医院辅助生殖中心的无精子症患者且资料齐全者共168例，年龄23～44岁，平均(29.52±4.38)岁；不育年限1～15年，平均(3.8±2.5)年；无精子症诊断标准为3次或3次以上精液离心未发现精子。 1.1.1入选标准：①双侧睾丸至少有一侧体积≥12ml，质地中等以上；