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目的分析不同病因梗阻性无精子症患者附睾液中的精子参数和细菌培养结果。方法将36例梗阻性无精子症患者按不同病因分成A、B和C 3组,A组(14例)为有明确附睾炎症病史的附睾炎症梗阻;B组(7例)为无明确生殖道炎症病史的精道梗阻;C组(15例)为先天性双侧输精管缺如。将这些患者行诊断性经皮附睾穿刺精子抽吸术(PESA),分析附睾液中的精子参数,同时将附睾液做常规细菌培养和结核杆菌培养。结果3组患者中,附睾精子密度≥20×10~6/ml,1～20×10~6/ml及≤1×10~6/ml的分别占33.3%(12/ 36),41.7%(15/36)和25%(9/36),各组间的精子密度无统计学差异(P>0.05);附睾液中有A或B级活动精子,仅有C级活动精子及仅有D级精子的患者分别占41.7%(15/36),36.1%(13/36)和22.2%(8/ 36),各组间的精子活动力无统计学差异(P>0.05);所有病例标本的常规细菌培养和结核杆菌培养均为阴性。结论对于不同病因导致精道梗阻的患者,附睾液中精子的密度和活动力无统计学差异,大多数PESA附睾液标本中的精子足够用于单精子卵胞浆内注射(ICSI)治疗;梗阻性无精子症患者非急性炎症期附睾液中不存在活动性细菌感染,可以安全应用于ICSI治疗。
Objective To analyze the sperm parameters and bacterial culture in epididymal fluid of patients with obstructive azoospermia. Methods Thirty-six patients with obstructive azoospermia were divided into groups A, B and C 3 according to different causes. Group A (14 cases) had epididymal inflammation obstruction with definite history of epididymal inflammation. Group B (7 cases) Fetal obstruction of the history of inflammation; C group (15 cases) congenital absence of bilateral vas deferens. These patients underwent diagnostic percutaneous epididymal sperm aspiration (PESA), analysis of sperm parameters in epididymal fluid, while the routine epidermal bacteria culture and Mycobacterium tuberculosis culture. Results Epididymal sperm density in the three groups were 33.3% (12/36) and 41.7% (20/40) respectively, with the sperm density of 20 × 10 ~ 6 / ml, 1 ~ 20 × 10 ~ 6 / ml and ≤ 1 × 10 ~ 15/36) and 25% (9/36) respectively. There was no significant difference in spermatozoa density between groups (P> 0.05). There were A or B sperm motility in the epididymal fluid, only C grade motile sperm and only D Sperms accounted for 41.7% (15/36), 36.1% (13/36) and 22.2% (8/36), respectively. There was no significant difference in sperm motility among all groups (P> 0.05). All cases The conventional bacterial culture and Mycobacterium tuberculosis culture were negative. Conclusion There was no significant difference in the density and activity of spermatozoa in epididymal fluid between patients with different causes of spermatic obstruction. Most of the spermatozoa in epididymal fluid samples of PESA were sufficient for ICSI treatment. Azoospermia in patients with non-acute inflammatory epididymal fluid is not active bacterial infection, can be safely applied to ICSI treatment.