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目的:回顾分析500例无精子症的临床诊治,为提高男性不育症规范化诊治水平提供参考。方法:回顾性分析2012年12月—2013年12月间收治的无精子症患者500例,根据中华医学会2013版《男科疾病诊治指南系列男性不育症诊疗指南》诊断为梗阻性、非梗阻性、混合性无精子症;分别提供附睾、输精管、射精管等精道重建手术、药物治疗、体外受精(IVF)/胞浆内单精子注射(ICSI)、供精人工授精(AID)及收养等方案供患者夫妇知情选择。结果:500例中梗阻性无精子症254例、非梗阻性无精子症187例、混合性无精子症40例,Y染色体AZFa或AZFb微缺失所致的无精子症19例。手术治疗的44例患者中,14例接受精囊镜射精管囊肿切开术、5例接受输精管-输精管吻合术、25例接受输精管-附睾吻合术;其中33例在术后3~12个月内行精液检查发现精子,2例在术后3~8个月女方自然妊娠;药物治疗的19例患者中,7例炎症性梗阻患者给予抗生素治疗1~3个月后,3例在3~6个月精液检查时发现精子,其中1例在治疗后5个月内女方自然妊娠,其余4例患者的生殖系统不适症状较前明显缓解;12例低促性腺激素患者给予卵泡刺激素(FSH)和(或)人绒毛膜促性腺激素(h CG)治疗,其中包括1例Kallmann综合征,9例患者经3~12个月随访,睾丸体积明显增大(>4~8 m L),血清睾酮明显增高,其中5例在6~12个月内精液中出现精子;IVF/ICSI治疗组的376例患者12个月内成功妊娠者196例;其余61例选择AID或收养。结论:依据中华医学会《男科疾病诊治指南系列男性不育症诊疗指南》谨慎有创操作,倡导医患共同决策诊疗行为,对于临床上无精子症规范化与合理的诊治具有积极意义。
Objective: To retrospectively analyze the clinical diagnosis and treatment of 500 cases of azoospermia and provide references for improving the standard diagnosis and treatment of male infertility. Methods: A retrospective analysis of 500 patients with azoospermia admitted from December 2012 to December 2013 was diagnosed as obstructive and non-obstructive according to the 2013 Chinese Medical Association Guide to Diagnosis and Treatment of Male Infertility Sex, mixed azoospermia; respectively provide fine reconstruction surgery such as epididymis, vas deferens and ejaculatory duct, drug therapy, in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI), artificial insemination (AID) and adoption Other programs for the informed choice of patients and couples. Results: A total of 254 cases of obstructive azoospermia in 500 cases, 187 cases of non-obstructive azoospermia, 40 cases of mixed azoospermia, and 19 cases of azoospermia caused by microdeletions of AZFa or AZFb were identified. Of the 44 patients undergoing surgical treatment, 14 received seminal vesicle ejaculated elective cyst excision, 5 received vas deferens-vas deferens anastomosis and 25 received vasectomy-epididymis anastomosis. Of these, 33 received postoperative 3 to 12 months Semen was found in sperm and natural pregnancy was observed in 2 women 3 to 8 months after surgery. Of the 19 patients treated with antibiotics, 7 were treated with antibiotics for 1 to 3 months and 3 to 6 Spermatozoa were found on the monthly semen examination, of which 1 patient was pregnant within 5 months after treatment, and the other 4 patients were relieved of their reproductive system discomfort earlier than before. In 12 patients with low gonadotropin, follicle stimulating hormone (FSH) and Or hCG, including 1 case of Kallmann syndrome, 9 cases of patients were followed up for 3 to 12 months, testicular volume was significantly increased (> 4 ~ 8 m L), serum testosterone Spermatozoa were found in 5 cases in 6 ~ 12 months; 376 cases in IVF / ICSI group had 196 cases of successful pregnancy in 12 months; the other 61 cases chose AID or adopted. Conclusion: According to the guidelines of “Guidelines for Diagnosis and Treatment of Male Infertility in Menopathies” issued by the Chinese Medical Association, it is of great importance to advocate common diagnosis and treatment of doctors and patients based on the careful and invasive procedures. It is of great significance to the standardization and reasonable diagnosis and treatment of azoospermia.