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目的探讨射精管梗阻性无精子症的诊断及经尿道射精管电切术(TURED)的可行性和疗效。方法回顾分析2003年6月～2005年9月间收治的46例射精管梗阻性无精子症患者的临床资料。采用精液常规分析、精浆果糖测定和经直肠超声检查(TRUS)对其进行诊断,患者均使用TURED治疗,术后随访至少3个月以上。结果46例患者精液量0．4～1．9ml,pH值5．6-7．0,精浆果糖降低,一次射精(0～10．8)μmol。TRUS检查：单纯双侧精囊扩张8例,单侧精囊扩张3例,精囊扩张并射精管扩张18例,精囊扩张合并前列腺囊肿者12例,单纯射精管部分扩张或前列腺囊肿者5例。所有患者均完成手术。术后随访3～28个月,40例(86．96%)精液检查有不同程度的改善,22例(47．82%)精液中出现精子,9例(19．56%)精液检查正常；4例(8．7%)妻子妊娠。结论精液分析、精浆果糖测定和TRUS是射精管梗阻的主要诊断方式。TURED是治疗射精管梗阻性无精子症的首选方法。
Objective To investigate the diagnosis and treatment of obstructive azoospermia and the feasibility and efficacy of transurethral ejaculatory duct transesophagectomy (TURED). Methods The clinical data of 46 patients with obstructive azoospermia undergoing ectopic endoscopy from June 2003 to September 2005 were analyzed retrospectively. Routine semen analysis, refined fructose determination, and transrectal ultrasound (TRUS) were used to diagnose TURED patients. All patients were followed up for at least 3 months. Results 46 patients seminal fluid 0.4 ~ 1.9ml, pH 5.6-7.0, fructose reduced seminal plasma, a ejaculation (0 ~ 10.8) μmol. In TRUS examination, there were 8 cases of simple bilateral seminal vesicle expansion, 3 cases of unilateral seminal vesicle expansion, 18 cases of seminal vesicle dilatation and ejaculatory duct dilatation, 12 cases of seminal vesicle expansion combined with prostatic cyst, 5 cases of partial ectocentesis or prostatic cyst. All patients completed the operation. There were 40 (86.96%) semen tests with varying degrees of improvement. Sperm was found in 22 (47.82%) semen and 9 (19.56%) semen were normal; Four patients (8.7%) were pregnant. Conclusions Seminal fluid analysis, determination of plasma fructose, and TRUS are the primary diagnostic modalities for ejaculatory duct obstruction. TURED is the treatment of ejaculatory duct obstruction azoospermia preferred method.