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目的分析炎症梗阻性无精子症的临床评估和单精子卵胞浆内注射(ICSI)的治疗结局。方法前瞻性研究近5年间接受ICSI治疗的炎症性梗阻性无精子症的临床特征、精液和超声特点,经皮附睾穿刺精子抽吸术(PESA)或经皮睾丸穿刺取精术(TEFNA)结合ICSI治疗后观察受精、临床妊娠等结果。结果146例患者体检附睾均有增粗变硬或伴头尾部结节。82例患者曾有生育史、附睾炎症史或输精管附睾吻合手术史,其中72例PESA找到附睾精子;53例无上述病史者49例PESA找到附睾精子:另有精道远端梗阻11例。ICSI治疗146例167周期炎症性梗阻性无精子症的受精率、每周期临床妊娠率分别为81.1%和42.1%。结论炎症梗阻性无精子症具备典型的临床和超声特征,PESA附睾精子获取率高,ICSI治疗获得较高受精率和临床妊娠率。
Objective To analyze the clinical evaluation of obstructive azoospermia and the therapeutic outcome of intracytoplasmic sperm injection (ICSI). Methods A prospective study of the clinical features, sperm and ultrasound features, percutaneous epididymal puncture sperm aspiration (PESA) or percutaneous testicular biopsy (TEFNA) combined with ICSI for the treatment of inflammatory obstructive azoospermia (ICSI) Observed after ICSI fertilization, clinical pregnancy and other results. Results 146 cases of patients with epididymal testicular thickening or stiffening or tailed nodules. There were 82 cases of history of childbirth, history of epididymitis or history of epididymal anastomosis, of which 72 cases of epididymal sperm were found in PESA; 53 cases of epididymal sperm were found in 49 cases of PESA; ICSI treatment of 146 patients with 167 cycles of inflammatory obstructive azoospermia fertilization rate of clinical pregnancy per cycle were 81.1% and 42.1%. Conclusion Inflammatory obstructive azoospermia has the typical clinical and ultrasonic features. The acquisition rate of epididymal sperm in PESA is high, and ICSI treatment achieves higher fertilization rate and clinical pregnancy rate.